Gastric bypass

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  • (BQ) Part 2 book "Minimally invasive bariatric surgery" presents the following contents: Laparoscopic adjustable gastric banding - outcomes, laparoscopic adjustable gastric banding - long-term management, laparoscopic adjustable gastric banding - management of complications, laparoscopic adjustable gastric banding - controversies

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  • The field of general surgery has changed dramatically over the last ten years with the acceptance of laparoscopy as an extension of the scalpel. Once ridiculed by most academic centers, laparoscopy has revolutionized the management of biliary tract disease and has led to a critical reassessment of how patients with other general surgical problems are managed. The rapid advancement and acceptance of laparoscopy as a part of general surgery is apparent today since most academic centers have laparoscopic sections and many offer laparoscopic fellowships....

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  • The three restrictive-malabsorptive bypass procedures combine the elements of gastric restriction and selective malabsorption. These procedures include Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion (BPD), and biliopancreatic diversion with duodenal switch (BPDDS) (Fig. 75-2). RYGB is the most commonly performed and accepted bypass procedure. It may be performed with an open incision or laparoscopically.

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  • It is common practice to recommend nutritional supplementation, such as multi-vitamins and iron, following bariatric surgery for all patients. However, evidence is scarce regarding specific recommendations for pregnant women. We did not identify any randomized studies assessing this question of efficacy of management strategies. Studies evaluating pregnancy following laparoscopic adjustable gastric banding or gastric bypass have shown minimal nutritional adverse events; however, most of these studies monitored and ensured that the women complied with vitamin supplementation.

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  • Table 100-4 Malabsorption of Cobalamin May Occur in the Following Conditions But Is Not Usually Sufficiently Severe and Prolonged to Cause Megaloblastic Anemia Gastric causes Simple atrophic gastritis (food cobalamin malabsorption) Zollinger–Ellison syndrome Gastric bypass surgery Use of proton pump inhibitors Intestinal causes Gluten-induced enteropathy Severe pancreatitis HIV infection Radiotherapy Graft-versus-host disease Deficiencies of cobalamin, folate, protein, ?riboflavin, ?nicotinic acid Therapy with colchicine, para-aminosalicylate, neomycin, slow-release potas...

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  • Nutrient deficiencies were reported in infants born to women who underwent procedures that resulted in malabsorption, as well as women who did not take prenatal vitamins or had difficulty with their own nutrition (i.e., from chronic vomiting). Literature suggests that gastric bypass and laparoscopic adjustable band procedures confer only minimal, if any, increased risk of nutritional or congenital problems if supplemental vitamins are taken and maternal nutrition is otherwise adequate. Biliopancreatic diversion has an appreciable risk for nutritional problems in some patients.

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  • We did not identify any prospective cohort studies, which would be the strongest study design to assess this question of risk. Consequently, our conclusions are tempered by the limited available evidence. Based on these data, gastric bypass and laparoscopic adjustable band seem to confer minimal if any risk for nutrient problems, as long as maternal nutrition is maintained.

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  • Something amazing happened aft er my husband, Dan, and I had weight-loss surgery. Th e amazing thing wasn’t that we had this procedure together, on the same day, in the same hospital, with the same surgeon. It wasn’t just losing weight, even though in the following eight months, we had lost 300 pounds between us. It was a combination of everything. Triggered by the surgery, our health began improving from the very fi rst day. Th e weight loss reversed medical conditions such as high blood pressure, hypertension, joint and back pain, and even diabetes.

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  • Previous results have shown that theoncoembryonicmarker a-fetoprotein (AFP) is able to induce apoptosis in tumor cells through activation of caspase 3, bypassing Fas-dependent and tumor necrosis factor receptor-dependent signaling. In this study we further investigate the molecular interactions involvedin the AFP-mediatedsignaling of apoptosis. We show that AFP treatment of tumor cells is accompaniedby cytosolic translocation of mitochondrial cytochromec.

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