Chronic abdominal pain after RYGB A management guide
|
|
- Hugh Barber
- 5 years ago
- Views:
Transcription
1 OBES 21 st October 2017 Chronic abdominal pain after RYGB A management guide Dr Chun-Hai Tan MBBS, Masters of Medicine (Surgery), FRCS (Edinburgh) Consultant Surgeon Metabolic & Bariatric Surgery, Minimally Invasive Upper GI Surgery Department of General Surgery Khoo Teck Puat Hospital
2 Conflict of Interest No conflict of interest to declare
3 Outline Abdominal pain is common after RYGB Causes Maladaptive eating Candy cane syndrome Constipation Dumping Syndrome Gallstones Marginal Ulcers Internal Hernia ** Management algorithm Detailed history & Examination Upper Endoscopy & Barium Swallow CT Scan Diagnostic Laparoscopy
4 Khoo Teck Puat Hospital, Singapore
5 Introduction Abdominal pain is one of the most common complaint after RYGB % of patients will visit the emergency room or require admission within three years of gastric bypass >50% Abdominal pain 2 nd most common - Vomitting Emergency room visits after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Cho M, Kaidar-Person O, Szomstein S, Rosenthal RJ, SOARD (2):104-9.
6
7 Maladaptive eating Maladaptive eating behavior is a common cause of abdominal pain in the early post-operative period Gastric bypass alters satiety and patients may not perceive fullness until pouch distension to the point of pain. Modifying behavior to eat slowly and use defined portion sizes provides relief. Small bites Chew over prolonged period of time Counseling together with Bariatric Dietician
8 Candy Cane syndrome Symptoms Post-prandial abdominal pain Nausea Epigastric fullness Regurgitation of food, reflux? Related to Circular stapler used for construction of GJ
9 Candy Cane syndrome Resection of this candy cane complete and immediate resolution of symptoms Learning point Minimize redundancy in the roux limb during RYGB
10 Constipation Constipation is common in the early post-operative period and may be associated with abdominal pain Constipation may result from dehydration Laxatives and increased water intake provide simple solutions May worsen IBS and chronic abdominal pain after RYGB
11 Dumping syndrome Dumping syndrome after gastric bypass surgery is when food gets dumped directly from your stomach pouch into your small intestine without being digested. 2 types of dumping: Early and Late.
12 Early and late dumping Early dumping which occurs minutes after eating and can last up to 60 minutes. Symptoms: Sweating, flushing, lightheadedness, tachycardia, palpitations, desire to lie down, upper abdominal fullness, nausea, diarrhea, cramping, and active audible bowels sounds. Late dumping which occurs 1-3 hours after eating. Symptoms are related to reactive hypoglycemia Sweating, shakiness, loss of concentration, hunger, and fainting or passing out.
13 Dumping: what to do? Negative reinforcement. Patient is less likely to eat that food again. I shouldn t have eaten it the first time I definitely won t eat it again. Changes to diet Early dumping: Avoid refined sugars, high glycemic carbohydrates, or other foods that may be associated with the syndrome Late dumping: Half glass of orange juice about one hour after a meal may prevent the attack. Medications such as Acarbose or Somatostatin may be helpful if still symptomatic despite dietary changes
14 Gallstones Biliary colic Extreme weight loss formation of gallstones Removal of gallbladder only for patients who are symptomatic Possible biliary colic as a cause of abdominal pain after RYGB.
15
16 Marginal Ulcers One of the most common complications after RYGB 0.6% - 16% Common Presentations: Abdominal pain 63% Bleeding 24% Median 22months after surgery Risk Factors DM Length of pouch Smokers HP infection Rasmussen JJ et. al. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surg Endosc Jul; 21(7):
17 Internal hernia Internal hernia is an important cause of abdominal pain after gastric bypass with an incidence ranging from 1-9% Intermittent pain Severe consequences: bowel incarceration, bowel ischaemia Internal hernia is thought to occur most commonly within 2-3 years after RYGB, often with significant weight loss Aghajani E et. al. Internal hernia after gastric bypass: A new and simplified technique for laparoscopic primary closure of the mesenteric defects. J Gastrointest Surg Mar; 16(3):
18 Case Presentation 1
19 Case presentation 1 43yo Malay Female 132kg,BMI 48, OSA Sleeve 2009 Lost 40kg, OSA resolved 3 years later after pregnancy, weight regain back to 105kg with severe reflux symptoms RYGB 2012 Weight 87kg, OSA resolved, Reflux symptoms resolved
20 13months after RYGB Epigastric pain x 4/7 - Clenching - Intermittent, colicky - Worse after meals - No vomiting AXR: No obstruction OGD: No anastomotic ulcer, No obstruction CT Scan Non specific changes. No sign of obstruction or internal herniation No abnormal bowel thickening or dilatation
21 Diagnostic Laparoscopy Transverse colon Long length of small bowel loop in Peterson s space No evidence of IO Small bowel healthy Peterson s space hernia reduced and closed Alimentary Limb Discharged on POD1
22 Case presentation 2
23 Background Mdm JY 57 Chinese Female PMHx Class 1 Obesity BMI 31 Poorly controlled T2DM HbA1C 10.3% Insulin 60 units + SGLT2 HLD/HPT OSA RYGB Oct months post surgery Came in through A&E, Epigastric pain x 1/7 -Progressive and constant -Pain score 10/10 -Radiating to the back -A/w nausea -AXR: non specific changes, one loop of mildly dilated small intestine CT: closed loop obstruction of the jejenum without ischemia or perforation
24 Transition point
25 Mushroom sign SMA Mesenteric vessels
26 Diagnostic laparoscopy, laparotomy and resection of gangrenous bowel Intra-op findings: Loop of small bowel caught in small bowel mesenteric defect causing gangrenous segment Gangrenous bowel was part of Biliopancreatic limb, from DJ flexure to JJ anastomosis. Mesenteric defect closed Recovered well and was discharged on POD 6 Last review 11/10/16 Weight 57.8kg, BMI 23.2 Hba1c > 8.5 (11/2/16) Insulin requirement decreased from 60 unit per day to 10 unit HPT/HLD Rx also improved.
27
28
29
30 CT Imaging in Internal Hernias
31 Use of imaging Liberal use of imaging to rule out major life threatening complications - beware of false negatives Read the scans, not just the report Face to face discussion with radiologist Do not assume concerning imaging findings in early postoperative period as normal postop variants.
32 Twisting of mesentery around mesenteric vessels
33 Clustering of normal looking small bowel in one corner
34 Dilated small bowel, normal large bowel
35 The mushroom sign: mushroom shape of the mesenteric root as it herniates through the J-J Mushroom sign
36 Hurricane Eye Sign: Tubular shape/column of mesenteric fat in corkscrew configuration
37 J-J anastomosis over the right side of abdomen
38 Internal herniation post RYGB Three potential location Type of herniation depends on configuration of Roux limb A. Transverse mesocolic defect (unique to the retrocolic approach) B. Petersen s space C. Jejuno-jejunal mesenteric defect Recommend Routine closure of defects Carmody B, DeMaria EJ, Jamal M, et al. Internal hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1:
39 Risk Factors for internal hernia Higher incidence of internal hernia after laparoscopic RYGB compared to open 1 Reduced bowel manipulation and peritoneal irritation Fewer postoperative adhesions Reduced fixation of the Roux limb and less scarring to help close mesenteric defects. Rapid weight loss leads to opening of more mesenteric spaces normally not open 1 Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13: Schneider C, Cobb W, Scott J, et al. Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal hernia. Surg Endosc 2011;2013:1594 8
40 Treatment Principle Prevention Close all potential hernia sites Non-absorbable sutures Early surgical intervention Diagnostic Laparoscopy Hernia reduction Repair defects
41 Management Algorithms Recurrent abdominal pain after RYGB Detailed history: maladaptive eating, biliary colic. RF: Smoking, DM Upper GI endoscopy: Marginal ulcers Barium Swallow: Candy cane No specific etiology apparent, CT abdomen CT negative but persistent symptoms Consider Diagnostic Laparoscopy CT positive for etiology: Rx appropriately
42 Conclusion Abdominal pain is common post RYGB Diagnosis to entertain Maladaptive eating Candy cane syndrome Constipation Dumping Syndrome Gallstones Marginal Ulcers Internal Hernia **
43 Conclusion Detailed history and examination is important Upper Endoscopy Barium swallow, contrast study CT Scan Early diagnosis saves bowel There are many CT signs to suggest bowel compromise Always go and talk to your radiologist (face to face consult, and review the scans together) If symptoms persist, consider diagnostic laparoscopy.
44 Better a negative laparotomy, than a positive post mortem Better a negative diagnostic laparoscopy, than a positive dead bowel and a very dead patient Chun-Hai Tan OBES 2017
45 Thank you 谢谢大家
Postgastrectomy Syndromes
Postgastrectomy Syndromes Postgastrectomy syndromes are iatrogenic conditions that may arise from partial gastrectomies, independent of whether the gastric surgery was initially performed for peptic ulcer
More informationCase Internal herniation with bowel ischemia after Roux-en-Y gastric bypass surgery.
Case 14127 Internal herniation with bowel ischemia after Roux-en-Y gastric bypass surgery. Peters B 1, 2, Waked K 3, Vanhoenacker FM 1, 2, 4, Ceulemans J 5, Mespreuve M 2, 4 University Hospital Antwerp,
More informationInternal hernias after laparoscopic Roux-en-Y gastric bypass
The American Journal of Surgery 188 (2004) 796 800 Scientific paper Internal hernias after laparoscopic Roux-en-Y gastric bypass Ernesto Garza, Jr., M.D., Joseph Kuhn, M.D., David Arnold, M.D., William
More informationNot over when the surgery is done: surgical complications of obesity
Not over when the surgery is done: surgical complications of obesity Gianluca Bonanomi, MD, FRCS Consultant Surgeon and Honorary Senior Lecturer Chelsea and Westminster Hospital London The Society for
More informationGastric bypass vs. Sleeve gastrectomy
Gastric bypass vs. Sleeve gastrectomy SLEEVEPASS-study Sleeve gastrectomy Paulina Salminen, M.D., PhD Turku University Hospital Department of Surgery Stockholms Obesitasdagar 19.4.2012 Swedish Obese Subjects
More information11/11/2011. Bariatric Surgery for Sleep Apnea. Case Presentation: Rachelle. Case Presentation: Rachelle. Case Presentation: Rachelle
Bariatric Surgery for Sleep Apnea 2,000 B.C. 2,000 A.D. 35 year-old woman with morbid obesity. 5 1 236 lbs BMI 44.5 PMHx: mild depression obstructive sleep apnea (AHI 42, on CPAP) asthma polycystic ovarian
More informationCommonly Performed Bariatric Procedures in Singapore. Lin Jinlin Associate Consultant General, Upper GI and Bariatric Surgery Changi General Hospital
Commonly Performed Bariatric Procedures in Singapore Lin Jinlin Associate Consultant General, Upper GI and Bariatric Surgery Changi General Hospital Scope 1. Introduction 2. Principles of bariatric surgery
More informationAntecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study
Surgery for Obesity and Related Diseases 3 (2007) 423 427 Original article Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study Alex Escalona, M.D.
More informationComplications after laparoscopic gastric bypass for morbid obesity. Background LGBP. Eirik Hornes Halvorsen, MD, PhD Oslo
Complications after laparoscopic gastric bypass for morbid obesity Eirik Hornes Halvorsen, MD, PhD Oslo 20.05.2015 Background Ca 3000 patients are surgically treated for morbid obesity in Norway each year.
More informationComplications After Bariatric Surgery. Kunoor Jain-Spangler, MD
Complications After Bariatric Surgery Kunoor Jain-Spangler, MD Disclaimer This topic could be a 2-3 day course. Will focus on common clinical conditions seen by Primary Care Physicians in the office setting.
More informationBenefits of Bariatric Surgery
Benefits of Bariatric Surgery Dr Tan Bo Chuan Registrar, Department of Surgery GP Forum 27 May 2017 Improvements of Co-morbidities Type 2 diabetes mellitus Hypertension Hyperlipidemia Degenerative joint
More informationBariatric Surgery Risk Education Packet Walter J. Chlysta MD, FACS
Date: Patient Name: Height: Weight: Ideal Body Weight: Excess Weight: Realistic Gastric Bypass Weight Goal (77 % Excess weight loss): Realistic Sleeve Gastrectomy Weight Goal (70 % Excess weight loss):
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,100 116,000 120M Open access books available International authors and editors Downloads Our
More informationAn Introduction to Bariatric Surgery
An Introduction to Bariatric Surgery What is bariatric surgery? Bariatric surgery is a treatment used to help people with obesity manage their health and weight. Why use surgery to manage obesity? Obesity
More informationHere are some types of gastric bypass surgery:
Gastric Bypass- Definition By Mayo Clinic staff Weight-loss (bariatric) surgeries change your digestive system, often limiting the amount of food you can eat. These surgeries help you lose weight and can
More informationViriato Fiallo, MD Ursula McMillian, MD
Viriato Fiallo, MD Ursula McMillian, MD Objectives Define obesity and effects on society and healthcare Define bariatric surgery Discuss recent medical management versus surgery research Evaluate different
More informationUNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN
UNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN Radiology Enterprises radiologyenterprises@gmail.com www.radiologyenterprises.com STOMACH AND SMALL BOWEL STOMACH AND SMALL BOWEL Swallowed air is a
More informationBariatric Surgery: How complex is this? Pradeep Pallati, MD, FACS, FASMBS
Bariatric Surgery: How complex is this? Pradeep Pallati, MD, FACS, FASMBS Nothing to Disclose Types of Bariatric Surgery Restrictive Malabsorptive Combination Restrictive and Malabsorptive Newer Endoluminal
More informationRe-do Roux-en-Y Gastric Bypass in a Patient with Known Midgut Malrotation
CASE REPORT Re-do Roux-en-Y Gastric Bypass in a Patient with Known Midgut Malrotation Muhammad Ali Karim, MRCS, Moustafa Mansour, MRCS, Abdulmajid Ali, FRCS, FRCS (Glasgow) ABSTRACT A 40-year-old woman
More informationMesenteric Defect Closure Decreases the Incidence of Internal Hernias Following Laparoscopic Roux-En-Y Gastric Bypass: a Retrospective Cohort Study
OBES SURG (2016) 26:2029 2034 DOI 10.1007/s11695-016-2049-8 ORIGINAL CONTRIBUTIONS Mesenteric Defect Closure Decreases the Incidence of Internal Hernias Following Laparoscopic Roux-En-Y Gastric Bypass:
More informationLaparoscopic Gastric Bypass Information
1441 Constitution Boulevard, Salinas, CA 93906 (831) 783-2556 www.natividad.com/weight-loss (Roux-en-Y Gastric Bypass) What is gastric bypass surgery? Gastric bypass surgery, a type of bariatric surgery
More informationHow can the surgeon help? M. Lannoo B. Navez
How can the surgeon help? M. Lannoo B. Navez 1 Reimbursed indications > 18 year BMI > 40 BMI >35 in combination with: OSAS Hypertension with 3 anti-hypertensive drugs Diabetes type II Multidisciplinary
More informationSurgical Management of Obesity. David A. Edelman, MD, MSHPEd, FACS Associate Professor of Surgery
Surgical Management of Obesity David A. Edelman, MD, MSHPEd, FACS Associate Professor of Surgery Objectives Describe indications for surgical management of obesity Describe three types of bariatric surgery
More informationGastrointestinal Surgery for Severe Obesity 2.0 Contact Hours Presented by: CEU Professor
Gastrointestinal Surgery for Severe Obesity 2.0 Contact Hours Presented by: CEU Professor 7 www.ceuprofessoronline.com Copyright 8 2007 The Magellan Group, LLC All Rights Reserved. Reproduction and distribution
More informationLecture Goals. Body Mass Index. Obesity Definitions. Bariatric Surgery What the PCP Needs to Know 11/17/2009. Indications for bariatric Surgeries
Bariatric Surgery What the PCP Needs to Know Mouna Abouamara Assistant Professor Internal Medicine James H Quillen College Of Medicine Lecture Goals Indications for bariatric Surgeries Different types
More informationImaging findings in complications of bariatric surgery.
Imaging findings in complications of bariatric surgery. Poster No.: C-1791 Congress: ECR 2012 Type: Educational Exhibit Authors: A. Fernandez Alfonso, G. Anguita Martinez, D. C. Olivares Morello, C. García
More informationRevision For Weight Regain
Revision For Weight Regain When? Why? What? Ahmad Aly ANZMOSS Dietetics Workshop 2018 Reoperative Surgery What Is Reoperative? Reversal Correction Conversion } Revisional Surgery Revisional Surgery 4000
More informationBariatric Surgery. The Oregon Bariatric Center Surgical Team
Bariatric Surgery The Oregon Bariatric Center Surgical Team Colin MacColl, MD, Medical Director, Bariatric Surgeon Jessica Folek, MD, Bariatric Surgeon I have no disclosures Disclosures Objectives What
More informationChristopher Lau Kings County Hospital SUNY Downstate Medical Center February 24, 2011
Christopher Lau Kings County Hospital SUNY Downstate Medical Center February 24, 2011 37 year old male presented with 1 day history of abdominal pain Pain was diffuse but worst in the epigastric area No
More informationConsent Form for. Bariatric weight-losing surgery
Consent Form for Version 03/17 Bariatric weight-losing surgery Morbid obesity is a risk factor for the development of diseases such as diabetes, hypertension, sleep apnea, excess lipids in the blood, heart
More informationInternal Hernia After Gastric Bypass: Sensitivity and Specificity of Seven CT Signs with Surgical Correlation and Controls
CT of Hernia After Gastric Bypass Abdominal Imaging Original Research Mark E. Lockhart 1 Franklin N. Tessler 1 Cheri L. Canon 1 J. Kevin Smith 1 Matthew C. Larrison 1 Naomi S. Fineberg 2 Brandon P. Roy
More informationAdipocytes, Obesity, Bariatric Surgery and its Complications
Adipocytes, Obesity, Bariatric Surgery and its Complications Daniel C. Morris, MD, FACEP, FAHA Senior Staff Physician Department of Emergency Medicine Objectives Basic science of adipocyte Adipocyte tissue
More informationADULT RETROGRADE INTUSSUSCEPTION Brian Tiu Richmond University Medical Center September 3, 2015
ADULT RETROGRADE INTUSSUSCEPTION Brian Tiu Richmond University Medical Center September 3, 2015 CASE PRESENTATION 41 yo woman presented one day hx abdominal pain, worsening nausea/vomiting denied flatus/bm
More information7th International Congress of the Spanish Society of Obesity Surgery. Valladolid Spain May, 2004.
7th International Congress of the Spanish Society of Obesity Surgery. Valladolid Spain May, 2004. DIMINISHING POSTOPERATIVE RISKS OF GASTRIC BYPASS Stenosis Stenosis Leak Leak Bleeding Bleeding Stenosis
More informationA Trip Through the GI Tract: Common GI Diseases and Complaints. Jennifer Curtis, MD
A Trip Through the GI Tract: Common GI Diseases and Complaints Jennifer Curtis, MD Colon Cancer How does it develop? Most cancers arise from polyps Over time these can turn into cancer Combination of genetic
More information3 Things To Know About Obesity Surgery
3 Things To Know About Obesity Surgery Dr Jon Armstrong 1st Edition Introduction... 3 1. Am I A Candidate?... 4 2. What Are The Options?... 5 3. How Does It Work?... 6 Conclusion... 9 Follow me here...
More informationTechnique. Matthew Bettendorf, MD Essentia Health Duluth Clinic. Laparoscopic approach One 12mm port, Four 5mm ports
Matthew Bettendorf, MD Essentia Health Duluth Clinic Technique Laparoscopic approach One 12mm port, Four 5mm ports Single staple line with no anastamosis 85% gastrectomy Goal to remove
More informationManaging obesity and the gastric bypass: understanding anatomy and major postoperative complications
Managing obesity and the gastric bypass: understanding anatomy and major postoperative complications Poster No.: C-1323 Congress: ECR 2015 Type: Educational Exhibit Authors: S. Tincey, A. N. Tavare, A.
More informationSmall Bowel and Colon Surgery
Small Bowel and Colon Surgery Why Do I Need a Small Bowel Resection? A variety of conditions can damage your small bowel. In severe cases, your doctor may recommend removing part of your small bowel. Conditions
More informationDisclosure Medtronic - Speaker/ Research Grant/ Robotics Advisory Board Gore - Education Grant/ Speaker Teleflex - Consultant Da Vinci - Proctor
Sleeve Plus Options Disclosure Medtronic - Speaker/ Research Grant/ Robotics Advisory Board Gore - Education Grant/ Speaker Teleflex - Consultant Da Vinci - Proctor Mederi - Speaker Novadaq - Advisory
More informationManaging Complications of Bariatric Surgery. Objectives
Managing Complications of Bariatric Surgery John J. Vargo, II, MD, MPH, FACG Chair, Department of Gastroenterology and Hepatology Digestive Disease and Surgery Institute Cleveland Clinic Cleveland, OH
More informationSafety of Laparoscopic Vs Open Bariatric Surgery. Dr. Kishore Nadkarni Director Nadkarni Group of Hospitals Killa Pardi, Vapi, Valsad, Surat
Safety of Laparoscopic Vs Open Bariatric Surgery 1 Dr. Kishore Nadkarni Director Nadkarni Group of Hospitals Killa Pardi, Vapi, Valsad, Surat Surgical Treatment of Obesity 2 Bariatrics is the branch of
More informationHernia. emoryhealthcare.org
Hernia Have you noticed a bulge or pain in your abdominal wall or groin? If so you may have a hernia. You may be in the process of confirming this diagnosis with your Primary Care Physician or already
More information6/23/2011. Bariatric Surgery: What the Primary Care Provider Should Know. Case Presentation: Rachelle
Bariatric Surgery: What the Primary Care Provider Should Know 2,000 B.C. 2,000 A.D. Case Presentation: Rachelle 35 year-old woman with morbid obesity. 5 1 236 lbs BMI 44.5 PMHx: mild depression obstructive
More informationA Bariatric Patient in my Waiting Room: Choosing the Right Patient for the Right Operation: Bariatric Surgery Indications
A Bariatric Patient in my Waiting Room: Choosing the Right Patient for the Right Operation: Bariatric Surgery Indications Shahzeer Karmali MD FRCSC FACS Associate Professor Surgery University of Alberta
More informationWhen to Refer for OGD and the Work Up of Upper GI Malignancies
When to Refer for OGD and the Work Up of Upper GI Malignancies Dr Hong Qiantai Registrar, Department of Surgery GP Forum 27 May 2017 38 year old female, non-smoker, BMI 29 Works as investment banker Presents
More informationGoals 1/9/2018. Obesity over the last decade Surgery has become a safer management strategy Surgical options for management
The Current State of Surgical Intervention in Management of Morbid Obesity Goals Obesity over the last decade Surgery has become a safer management strategy Surgical options for management 1 Goals Obesity
More informationManagement von Komplikationen in der Adipositaschirurgie D. Kröll, M.D.
Management von Komplikationen in der Adipositaschirurgie D. Kröll, M.D. University Obesity Centre Bern Department of Visceral Surgery and Medicine, Inselspital Bern Bariatric Surgery Now Data ASMBS 2015
More informationGastric Bypass Surgery
Gastric Bypass Surgery Introduction Obesity is associated with many diseases such as diabetes, high blood pressure, heart problems, and degeneration of the joints. These diseases and the obesity itself
More informationObjectives. Pediatric Mortality. Another belly pain. Gastroenteritis. Spewing & Pooing Child 4/18/16
Gastro-tastrophies A Review of Pediatric GI Emergencies Objectives Discuss common presentations of Pediatric Abdominal Pain complaints Discuss work up and physical exam findings Discuss care, management
More informationGASTRIC BAND SURGERY THE FACTS THE QUESTIONS THE ANSWERS
GASTRIC BAND SURGERY THE FACTS THE QUESTIONS THE ANSWERS A COMPANION E-BOOK FOR ANYONE CONSIDERING GASTRIC BAND, GASTRIC SLEEVE, OR GASTRIC BYPASS SURGERY www.gastricbandfrance.co.uk Tel: - 0033 686567031
More informationCase Report Transmesenteric Internal Herniation Leading to Small Bowel Obstruction Postlaparoscopic Radical Nephrectomy
Hindawi Case Reports in Surgery Volume 2017, Article ID 5128246, 4 pages https://doi.org/10.1155/2017/5128246 Case Report Transmesenteric Internal Herniation Leading to Small Bowel Obstruction Postlaparoscopic
More informationConsecutive, Bilateral Obturator Hernia in a Single Case HO Aydın¹, EHA Soy¹, T Avcı¹, T Tezcaner¹, S Yıldırım ABSTRACT
Consecutive, Bilateral Obturator Hernia in a Single Case HO Aydın¹, EHA Soy¹, T Avcı¹, T Tezcaner¹, S Yıldırım ABSTRACT Obturator hernia (OH) is a rare pelvic hernia. It is diffucult to make an early diagnosis
More informationBariatric Surgery. Options & Outcomes
Bariatric Surgery Options & Outcomes Obesity Obesity now leading cause of premature death & illness in Australia 67% of Australians are overweight or obese Australia 4 th fattest nation in OECD Obesity
More informationOverview. Stanley J. Rogers, MD, FACS Associate Clinical Professor of Surgery University of California San Francisco
GASTROINTESTINAL COMPLICATIONS AFTER BARIATRIC SURGERY Stanley J. Rogers, MD, FACS Associate Clinical Professor of Surgery University of California San Francisco UCSF DEPARTMENT OF SURGERY Original Article
More informationMohamed EL-hemaly Gastro- intestinal surgical center, Mansoura University.
Mohamed EL-hemaly Gastro- intestinal surgical center, Mansoura University. Chronic transmural inflammatory process of the bowel & affects any part of the gastro -intestinal tract from the mouth to the
More informationBariatric Surgery. Overview of Procedural Options
Bariatric Surgery Overview of Procedural Options The Obesity Epidemic In 1991, NO state had an obesity rate above 20% 1 As of 2010, more than two-thirds of states (38) now have adult obesity rates above
More informationLaparoscopic Weight Loss Surgery (Bariatric Surgery) A simple guide to help answer your questions
Laparoscopic Weight Loss Surgery (Bariatric Surgery) A simple guide to help answer your questions Weight problems are growing in the US More than 100 million Americans are overweight Half of these people
More informationWeight Loss Surgery. Outline 3/30/12. What Every GI Nurse Needs to Know. Define Morbid Obesity & its Medical Consequences. Treatments for Obesity
3/30/12 Weight Loss Surgery What Every GI Nurse Needs to Know Kenneth A Cooper, D.O. March 31, 2012 Outline Define Morbid Obesity & its Medical Consequences Treatments for Obesity Bariatric (Weight-loss)
More informationGut involvement in PoTS an overview
Gut involvement in PoTS an overview Qasim Aziz, PhD, FRCP Centre for Neuroscience and Trauma Wingate Institute of Neurogastroenterology Case Hx * 28 year old lady presents with a long hx of constipation
More informationSleeve Gastrectomy: Harmful. John C. Eun, PGY-5 General Surgery Grand Rounds University of Colorado Denver 11/22/10
Sleeve Gastrectomy: Harmful John C. Eun, PGY-5 General Surgery Grand Rounds University of Colorado Denver 11/22/10 Background Obesity: Body Mass Index >30 Risk factor for CAD, DM, Cancers Obesity Trends*
More informationNordic Forum - Trauma & Emergency Radiology. Bowel Obstruction: Imaging Update
Nordic Forum - Trauma & Emergency Radiology Bowel Obstruction: Imaging Update Borut Marincek Institute of Diagnostic Radiology University Hospital Zurich, Switzerland Acute Abdomen Bowel Obstruction Bowel
More informationThe Surgical Management of Obesity
The Surgical Management of Obesity Omar al noubani MD,MRCS وك ل وا و اش ز ب وا و ال ت س رف وا األعراف ما مأل ابن آدم وعاء شر ا من بطنه Persons who are naturally fat are apt to die earlier than those who
More information10/16/2014. Normal Weight: BMI Overweight: BMI >25 Obese: BMI >30 Morbidly Obese: BMI >40 or >35 with 2 comorbidities
Brinton Clark, MD, MPH Department of Medical Education Providence Portland Medical Center October 25 th, 2014 Oregon Society of Physician Assistants Fall Conference 45 yo woman with BMI=40kg/m2 (weight
More informationRestrictive Procedures: Band and Sleeve
Restrictive Procedures: Band and Sleeve Jin S. Yoo M.D. Assistant Professor of Surgery Jin.Yoo@duke.edu Disclosures Speaker for Cook Medical, Covidien, W.L. Gore Consultant for Musculoskeletal Transplant
More informationGeneral Surgery Service
General Surgery Service Patient Care Goals and Objectives Stomach/Duodenum and Bariatric assessed for a) Obesity surgery b) Treatment of i) Adenocarcinoma of the stomach ii) GIST iii) Carcinoid 2) Optimize
More informationLEARNING OBJECTIVES. Obesity. Obesity. Consequences of Malnutrition in Obesity: Undernutrition Concurrent with Overnutriton. Obesity.
@PhD_Leigh #BariatricSurgery #Nutrition LEARNING OBJECTIVES Consequences of Malnutrition in : Undernutrition Concurrent with Overnutriton Leigh A. Frame, PhD, MHS Program Director in Integrative Medicine,
More informationFRESH START. Time For A BARIATRIC SURGERY! WHAT IS BARIATRIC SURGERY? UHS Medical Times EVERYTHING YOU NEED TO KNOW ABOUT علاج ال دانة وجراحة السمنة
UHS Medical Times 1 Newsletter September 2018 علاج ال دانة وجراحة السمنة MINIMALLY INVASIVE Time For A FRESH START EVERYTHING YOU NEED TO KNOW ABOUT BARIATRIC SURGERY! While any surgical procedure carries
More information10/28/11. Bariatric Surgery: What the Primary Care Provider Should Know. Case Presentation: Rachelle
Bariatric Surgery: What the Primary Care Provider Should Know 2,000 B.C. 2,000 A.D. Case Presentation: Rachelle 35 year-old woman with morbid obesity. 5 1 236 lbs BMI 44.5 PMHx: mild depression obstructive
More informationClinical Study Redo Surgery after Failed Open VBG: Laparoscopic Minigastric Bypass versus Laparoscopic Roux en Y Gastric Bypass Which Is Better?
Minimally Invasive Surgery Volume 2016, Article ID 8737519, 4 pages http://dx.doi.org/10.1155/2016/8737519 Clinical Study Redo Surgery after Failed Open VBG: Laparoscopic Minigastric Bypass versus Laparoscopic
More informationClassification and Management of Leaks after Gastric Bypass for Patients with Morbid Obesity: A Prospective Study of 60 Patients
OBES SURG (2012) 22:855 862 DOI 10.1007/s11695-011-0519-6 CLINICAL REPORT Classification and Management of Leaks after Gastric Bypass for Patients with Morbid Obesity: A Prospective Study of 60 Patients
More informationManagement of Small Bowel Obstruction: An Update. Case Presentation
Management of Small Bowel Obstruction: An Update The Postgraduate Course in General Surgery March 20-23, 2011 Jonathan Carter, MD Assistant Professor of Surgery Case Presentation 67 year old otherwise
More information3/21/2011. Case Presentation. Management of Small Bowel Obstruction: An Update. CT abdomen and pelvis. Abdominal plain films
Case Presentation 67 year old otherwise healthy woman presents to the ED with a chief complaint of abdominal pain, nausea and vomiting for five days. Management of Small Bowel Obstruction: An Update The
More informationThe first 6 weeks after gastric band/bypass surgery
Patient information The first 6 weeks after gastric band/bypass surgery Eating and drinking In the first 4-6 weeks after the operation it is vital that you keep to the diet that we have advised in order
More informationThe different types of internal hernia after laparoscopic Roux-En-Y gastric by-pass for morbid obesity: MDCT features
The different types of internal hernia after laparoscopic Roux-En-Y gastric by-pass for morbid obesity: MDCT features Poster No.: C-419 Congress: ECR 2009 Type: Educational Exhibit Topic: Abdominal and
More informationObesity Who is suitable for surgery? Professor Rob Andrews University of Exeter / Taunton NHS trust
Obesity Who is suitable for surgery? Professor Rob Andrews University of Exeter / Taunton NHS trust Investigator on BYBAND study Conflict of interest 3 Diet and Exercise studies (ACTID, EXTOD, STAMP2)
More informationSURGICAL MANAGEMENT OF OBESITY. Anne Lidor, MD, MPH Professor of Surgery Chief, Division of Minimally Invasive and Bariatric Surgery
SURGICAL MANAGEMENT OF OBESITY Anne Lidor, MD, MPH Professor of Surgery Chief, Division of Minimally Invasive and Bariatric Surgery Multi-Factorial Causes of Morbid Obesity include: Genetic Environmental
More informationMBSAQIP Complex Clinical Scenarios & Variable Review
MBSAQIP Complex Clinical Scenarios & Variable Review Disclosure The following planners, speakers, moderators, and/or panelists of the CME/CEU activity have no relevant financial relationships with commercial
More informationThis is the portion of the intestine which lies between the small intestine and the outlet (Anus).
THE COLON This is the portion of the intestine which lies between the small intestine and the outlet (Anus). 3 4 5 This part is responsible for formation of stool. The large intestine (colon- coloured
More informationImaging features of the complications of bariatric surgery
Imaging features of the complications of bariatric surgery Poster No.: C-2173 Congress: ECR 2014 Type: Authors: Educational Exhibit M. Lahkim 1, J. Lucas 2, A. HAMEG 3, P. Lacombe 4 ; 1 Rabat/MA, 2 Neuilly/Seine/FR,
More informationMorbid Obesity A Curable Disease?
Morbid Obesity A Curable Disease? Piotr Gorecki, M.D. F.A.C.S. Associate Professor of Clinical Surgery Weill Medical College of Cornell University Chief of Laparoscopic Surgery New York Methodist Hospital
More informationBariatric Surgical Complications and Recent Trends in Outcome Data
Bariatric and Metabolic Conference Bariatric Surgical Complications and Recent Trends in Outcome Data Daniel A.P. Smith, MD Bariatric Surgery Director Essentia Health Park Rapids St. Joseph s Center for
More informationMarc Bessler, M.D.*, Amna Daud, M.D., M.P.H., Teresa Kim, M.D., Mary DiGiorgi, M.P.H.
Surgery for Obesity and Related Diseases 3 (2007) 480 485 Original article Prospective randomized trial of banded versus nonbanded gastric bypass for the super obese: early results Marc Bessler, M.D.*,
More informationGastric Emptying Time after Laparoscopic Sleeve Gastrectomy
International Journal of Current Research in Medical Sciences ISSN: 2454-5716 P-ISJN: A4372-3064, E -ISJN: A4372-3061 www.ijcrims.com Original Research Article Volume 4, Issue 7-2018 Gastric Emptying Time
More informationPATIENT CONTRACT LAPAROSCOPIC VERTICAL SLEEVE GASTRECTOMY
PATIENT CONTRACT LAPAROSCOPIC VERTICAL SLEEVE GASTRECTOMY This contract is supported by my surgeon,, and will be effective and ongoing from the initial evaluation for a laparoscopic vertical sleeve gastrectomy.
More informationUncommon conditions in surgical oncology: acute abdomen caused by ileocolic intussusception
Case Report Uncommon conditions in surgical oncology: acute abdomen caused by ileocolic intussusception Karl Mrak Department of Surgery, Brothers of Mercy Hospital, St. Veit, Glan, Austria Correspondence
More informationMB03 Laparoscopic Gastric Bypass
Suite 1 Level 5, 123 Nerang Street, Southport Qld 4215 MB03 Laparoscopic Gastric Bypass Expires end of January 2019 Write questions or notes here: Further Information and Feedback: Tell us how useful you
More informationDON T LET OBESITY SPOIL YOUR HEALTH AND YOUR LIFE
July 2015 Issue No.17 DON T LET OBESITY SPOIL YOUR HEALTH AND YOUR LIFE www.sghgroup.com JEDDAH RIYADH MEDINA ASEER HAIL SANAA DUBAI CAIRO Definitions Over View and General Facts General Key facts! Worldwide
More informationBariatric Surgery Update
Bariatric Surgery Update Alexander Perez, MD, FACS Professor of Surgery Chief, Division Minimally Invasive and Foregut Surgery Speaker Disclosure Dr. Perez has disclosed that the has no actual or potential
More informationPathology of Intestinal Obstruction. Dr. M. Madhavan, MBBS., MD., MIAC, Professor of Pathology Saveetha Medical College
Pathology of Intestinal Obstruction Dr. M. Madhavan, MBBS., MD., MIAC, Professor of Pathology Saveetha Medical College Pathology of Intestinal Obstruction Objectives list the causes of intestinal obstruction
More informationDisclosure Statement. Covidien: Consultant, Grants
Disclosure Statement Covidien: Consultant, Grants Non-Invasive Bariatric Procedures Michel M. Murr, MD, FACS Director of Bariatric Surgery Metabolic and Bariatric Surgery Outline for Non-Invasive Bariatrics
More informationOBESITY AND WEIGHT LOSS SURGERY FOR THE PRIMARY CARE PHYSICIAN
OBESITY AND WEIGHT LOSS SURGERY FOR THE PRIMARY CARE PHYSICIAN Nicole Basa, M.D., F.A.C.S., F.A.S.M.B.S Assistant Professor of Surgery Texas A&M Medical School Bariatric Medical Director- Cedar Park Regional
More informationCurrent Trends in Bariatric Surgery
Current Trends in Bariatric Surgery 9.28.2017 Abraham Krikhely, MD, FACS, FASMBS Assistant Professor of Surgery, CUMC Center of Minimal Access, Metabolic and Weight Loss Surgery Outline Why consider surgery
More informationBariatric Surgery: Patient Selection, Complications, What the Internist Should Know
Bariatric Surgery: Patient Selection, Complications, What the Internist Should Know Valerie J. Halpin Legacy Weight and Diabetes Institute November 3, 2017 Surgical Overview Indications Contraindications
More informationA rare case of intestinal obstruction due to internal hernia. Dr. Jayanth 3 rd year PG Dept. Of General Surgery
A rare case of intestinal obstruction due to internal hernia Dr. Jayanth 3 rd year PG Dept. Of General Surgery One of the common cause of acute abdomen May lead to high morbidity and mortality if not treated
More informationObesity and Weight Loss Surgery for the Primary Care Physician
Saturday General Session Obesity and Weight Loss Surgery for the Primary Care Physician Nicole Basa, MD Bariatric and General Surgeon Cedar Park Surgeons, PA Cedar Park, Texas Educational Objectives By
More informationINFORMED CONSENT FOR LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS SURGICAL PROCEDURE
INFORMED CONSENT FOR LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS SURGICAL PROCEDURE It is very important to Venice Metabolic and Bariatric Surgery that you understand and consent to the treatment your doctor
More informationCatherine Kerschen DO, FACOI Michigan State University College of Osteopathic Medicine
Catherine Kerschen DO, FACOI Michigan State University College of Osteopathic Medicine none none Reserved for pts: Complications from GERD Refractory esophagitis** Stricture Barrett s Persistent reflux
More informationGeneral'Surgery'Service'
General'Surgery'Service' Patient Care Goals and Objectives 1)! Stomach/Duodenum and Bariatric 2)! Interpret the results of clinical evaluations (history, physical examination) performed on patients being
More informationTRANSOMENTAL HERNIATION CAUSING ACUTE INTESTINAL OBSTRUCTION N. Suresh Kumar 1, Rahul Rai 2, P. Kulandai Velu 3
TRANSOMENTAL HERNIATION CAUSING ACUTE INTESTINAL OBSTRUCTION N. Suresh Kumar 1, Rahul Rai 2, P. Kulandai Velu 3 HOW TO CITE THIS ARTICLE: N. Suresh Kumar, Rahul Rai, P. Kulandai Velu. Transomental Herniation
More information