1,720,965 research outputs found
The impact of the surgical technique on stenosis after laparoscopic sleeve gastrectomy: a single center study on 5235 patients
No full textBackground: Laparoscopic Sleeve Gastrectomy (LSG) has gained worldwide popularity in the last 10 years as self alone bariatric procedure. Symptomatic Stenosis (SS) is a potential severe postoperative complication and it can be divided in organic stenosis (OS) and functional stenosis (FS). The aim of this paper is to propose a modified surgical technique to prevent FS.
Methods: A retrospective review on 5235 LSG performed in Ponderas Academic Hospital between January 2011 and December 2019, searched FS in two consecutive patients groups, divided based on the modified surgical technique introduced in 2015, with fixation of the gastric tube to the pre-pancreatic fascia and stapler line's over-sewn running suture.
Results: Group A (2011-2014) included 1332 LSG, 16 SS were registered (1.2%), 7 OS and 9 FS; 3903 LSG included in group B (2015-2019), counting for 37 SS (0.95%), 27 OS and 10 FS. A statistically significant difference between the 2 groups was observed for the FS incidence (p=0.03), while it was non-significant for the OS (p=0.52) and the total number of SS (p=0.43). The endoscopic approach was used in forty-eight SS (90.5%) with a successful rate of 83%, while specifically for the FS it was 100%; only one complication was registered during endoscopic treatment, that required further surgical solution.
Conclusions: fixation of the gastric tube to the pre-pancreatic fascia and stapler line's over-sewn running suture during LSG, introduced lately, are beneficial in preventing the postoperative functional stenosis of the LSG, contributing to the improvement of the patient's quality of life
Salvation Gastric Bypass as Conversion from Failed, Open Banded Vertical Gastroplasty
No full textIntroduction: Vertical-banded gastroplasty used to be one of the most performed
bariatric procedures, but it fallen out of interest due to other emerging
procedures and non-satisfactory long-term results. Options for revision include
conversion to sleeve gastrectomy, a Roux-en-Y gastric bypass
(RYGB) or VBG reversal via gastrogastrostomy. Objectives: To evaluate
the role of laparoscopic RYGBP in the treatment of a previous, failed open
VBG. Methods: we present the video of a laparoscopic conversion from
previous open, adjustable banded vertical gastroplasty. Patient was operated
in other center in 1997 at a BMI of 55.3 kg/m2 and arrived a minimumof 30
kg/m2. In 2017 she presented for weight regain and reflux disease (BMI 41
kg/m2), requesting further attention. Intraoperative difficulties, adhesiolisys,
band removal, unexpected situations are presented. Results: Conversion to
laparoscopic RYGBP was safe and efficient, with no need for open surgery
conversion, and further weight loss recorded. Postoperative prolonged respiratory
problems registered, successfully treated conservatively. An important
improvement of the patients’ symptoms and satisfaction was achieved 6
months postoperatively, with suspension of medical therapy, at a BMI of 35
kg/m2. Conclusions: Conversion of open VBG to RYGB is feasible and safe
and can be performed with an acceptable complication rates, especially in
experienced bariatric centers. It gives excellentweight loss results and relief of
outlet obstruction
Splenic and concomitant liver abscess after laparoscopic sleeve gastrectomy
Get PDFIntroduction: Laparoscopic sleeve gastrectomy (LSG) is a safe and effective procedure for losing weight and gaining control of obesity-related comorbidities. However, it is associated with postoperative complications such as bleeding, leak, and midgastric stenosis. Splenic and hepatic abscesses have been reported as unusual and rare complications after primary LSG. We report a case of splenic and concomitant hepatic abscesses after primary LSG, successful minimally invasive management, and midterm follow-up.
Case Description: We report a complex case of splenic abscess with satellite hepatic abscess plus splenic thrombosis (0.1%) diagnosed 67 days after LSG. This unusual complication was managed by a minimally invasive approach (spleen sparing) with complete resolution after 35 days. After 18 months of follow-up, the patient showed complete resolution of the splenic and liver abscesses and progressive loss of excess weight.
Conclusion: In high-volume centers, rare and life-threatening complications such as splenic and hepatic abscesses may be observed. The minimally invasive approach could represent an effective option of avoiding splenectomy in selected case
Persistent fistula after sleeve gastrectomy: a chronic dilemma
Get PDFNu există limită de timp în ceea ce priveşte apariţia fistulelor după sleeve gastrectomy LSG, iar cele cu debut tardiv pot evolua către fistule persistente, cronice. Scopul acestui studiu retrospectiv a fost de a analiza incidenţa, tratamentul şi urmările după acestea, tratate într-un Centru de Excelenţă de chirurgie bariatrică şi de a dezvolta un tratament standard. Materiale şi Metode: între 2011-2018, 9 cazuri de fistule postoperatorii au apărut după un număr total de 1365 LSG (0,65%), 7 prezentând debut tardiv (minim 10 zile de la operaţie). Au fost identificate şi analizate fistulele cronice, persistente, inclusiv o fistulă gastro-bronhială şi una gastro-cutanată. Rezultate: prezentăm 3 cazuri particulare de fistule foarte tardive, cronice de tip III (fistule complexe), cu debut variind de la 6 până la 84 luni după LSG, şi tratamentul acestora (conservativ, radiologie şi/sau endoscopie intervenţională, chirurgical). Concluzii: managementul fistulelor tardive, cronice de tip III, este variabil, nestandardizat şi ar trebui planificat pe baza evoluţiei clinice, momentul diagnosticului, resursele disponibile şi expertiza locală. Un centru bariatric de excelenţă poate garanta un diagnostic şi tratament mai adecvat, pe baza resurselor şi a posibilităţilor existente.Background: There is no time limit for the occurrence of leaks after sleeve gastrectomy LSG, and very late ones might evolve versus persistent, chronic fistulas. The aim of this retrospective study was to analyze the incidence, treatment and outcomes of persistent, chronic fistulas occurred or treated in a bariatric Center of Excellence IFSO-EC (CoE) and to establish a standardized approach. Materials Methods: between 2011-2018, nine cases of postoperative leaks occurred on a total of 1365 LSG performed (0.65%), 7 of them having late presentations (onset over 10 days postoperative). Chronic, persistent fistulas were identified and analyzed, including one gastro-bronchial and one gastro-cutaneous fistulas. Results: We present three peculiar cases of very late, chronic type III fistulas, with onset at 6-84 months after primary LSG and their management, including conservative, interventional radiology and endoscopy and surgical therapies. Conclusions: the management of late, chronic type III fistula is variable, with no standard algorithm to follow, but it should be planned based on the clinical evaluation, time of diagnosis, available resources, multidisciplinary approach and expertise. This emphasises again the necessity of a bariatric CoE that can guarantee a better diagnose and treatment, based on the use of wide, available resources, both professional and material
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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