scholarly journals Management of Post-operative Leakage after Sleeve Gastrectomy (A Systematic Review)

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A I Khalil ◽  
M A Lasheen ◽  
I M Elzayyat ◽  
O R K Hammad

Abstract Background the prevalence of obesity and overweight have reached epidemic proportions in the last decades, with estimates by the World Health Organization (WHO) pointing that about 2 billion people are at least overweight worldwide. Aim of the Work to establish, through the available literature, what is the current management of leakage after sleeve gastrectomy in relation to each patient’s condition through the range of interventions available and their effectiveness. Materials and Methods the search is carried out using the electronic national library of medicine’s PubMed database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and its complications focusing on post-operative leakage. Electronic results were screened by title to exclude duplicate studies. Articles were identified by keywords: “laparoscopic sleeve gastrectomy” “leakage after sleeve” “gastric leak” and “management of leakage” and will be limited to research papers of all designed on human patients in English languish. Articles with no focus on leakage after sleeve gastrectomy were excluded from eligibility in this review. Results through this study, it is found that: 1- Early detection and management are very important to control the leak. 2- The early unstable patient should be operated for lavage and drainage and re-suturing of leak site if the tissue still healthy. 3- Management of the leakage after LSG still non-standardized and there are multiple treatment options, so it is important to carefully choose the best treatment options for each patient. Conclusion early diagnosis and deciding the best treatment option is important to reach a complete resolution of the leak. From this study, we concluded that treatment of gastric leak after LSG mainly depend on three factors; time of the leak, clinical presentation of the patient and site of the leak.

2021 ◽  
pp. 1-39
Author(s):  
Abdullah Al-Taiar ◽  
Nawal Alqaoud ◽  
Ali H. Ziyab ◽  
Faheema Alanezi ◽  
Monica Subhakaran ◽  
...  

Abstract Objectives: This study aimed to examine age-specific trends in the prevalence of overweight and obesity in schoolchildren in Kuwait over a 13-year period (2007 to 2019) using the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC) and the International Obesity Taskforce (IOTF) definitions. Design: Using cross-sectional approach, Kuwait Nutrition Surveillance System (KNSS) objectively measured weight and height of schoolchildren over a 13-year period. Log-binomial regression models were used to examine age-specific trends of obesity and overweight over the study period. Setting: Public primary, middle, and high schools in all provinces of Kuwait. Participants: Schoolchildren aged 5-19 years (N 172 603) Results: According to the WHO definition, the prevalence of overweight and obesity in schoolchildren respectively increased from 17.73% and 21.37% in 2007 to 20.19% and 28.39% in 2019 (P for trends<0.001). There is evidence that the obesity in females (but not males) has levelled off in the period 2014-2019 according to the three definitions of obesity, which is corroborated by a similar trend in the mean of BMI-for-age Z score. Conclusion: The prevalence of obesity and overweight in schoolchildren in Kuwait has risen over the last 13 years and trends are similar across all definitions. Obesity is no longer increasing at the same pace and there is evidence that the prevalence of obesity in females has plateaued. The current level of childhood overweight and obesity is too high and requires community-based and school-based interventions.


2019 ◽  
Vol 98 (5) ◽  
pp. 214-218

Obesity has become a global problem with increasing prevalence. Undoubtedly, bariatric surgery is the most effective way to treat morbid obesity. Laparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed bariatric procedure worldwide. The prevalence of gastroesopha- geal reflux disease (GERD) is also increasing, a close association with increasing prevalence of obesity being regarded as the main cause of this trend. The relationship between LSG and GERD is still unclear, at least controversial. If GERD occurs in the postoperative period, the first therapeutic intervention is initiation of proton pump inhibitors (PPI) treatment, which is effective in the vast majority of patients. In patients resistant to this treatment, conversion to laparoscopic Roux en Y gastric bypass (LRYGB) is usually necessary. The authors present the case report of a patient who developed GERD in the longer postoperative period and conversion to LRYGB was not appropriate due to previous complications and surgical procedures. Therefore, this patient was managed operatively by an alternative method – hiatoplasty with partial posterior fundoplication. The success of the treatment was confirmed clinically by disappearance of GERD symptomatology postoperatively even after PPI discontinuation. LRYGB is the method of choice for GERD after restrictive bariatric procedures. However, some patients are not suitable for conversion to LRYGB, and alternative treatment options are therefore needed.


Author(s):  
K. A. Anisimova ◽  
D. I. Vasilevskii ◽  
A. Ju. Korolkov ◽  
S. G. Balandov ◽  
A. S. Lapshin ◽  
...  

Gastric leak is the most dangerous postoperative complication of laparoscopic sleeve gastrectomy. Traditional surgical treatment options and endoscopic stent placement are not always successful. Negative Pressure Wound Therapy (NPWT) has shown itself like a new successful and feasible treatment option for leaks of different etiology after gastro-esophageal surgery.The initial body mass index (BMI) of the patient was 46 and co-morbidity was represented: arterial hypertension, type 2 diabetes and dyslipidemia. NPWT was initiated in 14 days after laparoscopic sleeve gastrectomy. The abdominal part of the system were changed 3 times for14 days. The patient was discharged from the hospital in 14 days after the secondary sutures to the wound. No relevant complications related to the procedure were observed during the course of the vacuum therapy. It combines defect closure, effective drainage and allows doing a periodic inspection of the wound cavity. NPWT is a successful, safety and effective treatment option for the leaks after laparoscopic sleeve gastrectomy 


2020 ◽  
Vol 33 (7-8) ◽  
pp. 505 ◽  
Author(s):  
Cristina Carvalho Gouveia ◽  
Luís Campos

Introduction: In December 2019, an outbreak of pneumonia caused by a novel coronavirus occurred in Wuhan, the capital of Central China’s Hubei Province and has been declared a public health emergency of international concern by the World Health Organization since January 2020.Material and Methods: A comprehensive search using the PubMed database was carried out to summarize the latest published information about the epidemiology, definition, pathogenesis, clinical characteristics, treatment options, prognosis and prevention of coronavirus disease 2019.Discussion: This new strain of coronavirus, named severe acute respiratory syndrome coronavirus 2, enters human cells that express angiotensin-converting enzyme II receptors, which exist in the respiratory, gastrointestinal and genitourinary tracts and heart, causing coronavirus disease. Transmission occurs essentially through the respiratory tract and the main symptoms are fever, cough and dyspnea. Diagnosis is based on epidemiological, clinical and imaging features and confirmed by nucleic acid testing.Conclusion: Despite intensive research, the exact origin of the virus and pathophysiology of coronavirus disease is not yet completely known, and clinically approved vaccines and drugs that target severe acute respiratory syndrome coronavirus 2 are lacking.


2020 ◽  
pp. 20-25
Author(s):  
Denise Sackett ◽  
Tala Dajani ◽  
David Shoup ◽  
Uzoma Ikonne

The benefits of breastfeeding are well established. The World Health Organization and the Centers for Disease Control and Prevention recommend that mothers breastfeed infants for at least one year, but most children are not breastfed that long because of many factors. Breastfeeding mothers face many challenges to continued breastfeeding, including medical conditions that arise during this period, such as postpartum depression and lactational mastitis. Because of a perceived lack of consistent guidance on medication safety, it can be difficult for the family physician to treat these conditions while encouraging mothers to continue breastfeeding. The purpose of the current review is to summarize and clarify treatment options for the osteopathic family physician treating lactating mothers. We specifically focus on the pharmacological management of contraception, postpartum depression, and lactational mastitis.


Author(s):  
Lara Bittmann

On December 31, 2019, WHO was informed of cases of pneumonia of unknown cause in Wuhan City, China. A novel coronavirus was identified as the cause by Chinese authorities on January 7, 2020 and was provisionally named "2019-nCoV". This new Coronavirus causes a clinical picture which has received now the name COVID-19. The virus has spread subsequently worldwide and was explained on the 11th of March, 2020 by the World Health Organization to the pandemic.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Betregiorgis Zegeye ◽  
Gebretsadik Shibre ◽  
Gashaw Garedew Woldeamanuel

Abstract Background The growing rates of obesity in developing countries are alarming. There is a paucity of evidence about disparities of obesity in Lesotho. This study examined socioeconomic and area-based inequalities in obesity among non-pregnant women in Lesotho. Methods Data were extracted from the 2004, 2009 and 2014 Lesotho Demographic and Health Surveys (LDHS) and analyzed through the recently updated Health Equity Assessment Toolkit (HEAT) of the World Health Organization. Obesity prevalence was disaggregated by four equity stratifiers, namely education, wealth, residence and sub-national region. For each equity stratifier, simple and complex as well as relative and absolute summary measures were calculated. A 95% confidence interval was used to measure statistical significance of findings. Results We noticed substantial wealth-driven (D = -21.10, 95% CI; − 25.94, − 16.26), subnational region (PAR = -11.82, 95%CI; − 16.09, − 7.55) and urban-rural (− 9.82, 95% CI; − 13.65, − 5.99) inequalities in obesity prevalence without the inequalities improved over time in all the studied years. However, we did not identify educational inequality in obesity. Conclusions Wealth-driven and geographical inequalities was identified in Lesotho in all the studied time periods while education related inequalities did not appear during the same time period. All population groups in the country need to be reached with interventions to reduce the burden of obesity in the country.


2012 ◽  
Vol 11 (2) ◽  
pp. 184
Author(s):  
Marcela Ribeiro da Costa ◽  
Durval Sobreiro Júnior ◽  
Crésio Alves

<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:HyphenationZone>21</w:HyphenationZone> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabela normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="margin: 0cm 22.7pt 0.0001pt; text-align: justify;"><strong><span style="font-size: 8pt; color: black;">Introdução</span></strong><span style="font-size: 8pt;"> <strong>- </strong>Apesar da ampla utilização e significativa correlação do IMC (Índice de Massa Corporal) com o diagnóstico de sobrepeso e obesidade, estudos recentes sugerem pouca associação dos valores intermediários de sobrepeso com o percentual de gordura corporal, o que pode subestimar a prevalência de elevada adiposidade e seus riscos à saúde. <strong>Métodos</strong> - Este estudo comparou o diagnóstico de mulheres consideradas eutróficas pelo critério de IMC preconizado pela OMS (Organização Mundial de Saúde) com a avaliação segundo o cálculo do percentual de gordura corporal aferido por pregas cutâneas. Foram analisadas as fichas de avaliação física de duzentas e quatro alunas matriculadas em uma academia exclusiva para mulheres de Salvador, Bahia, em 2010. Foram analisados peso, altura, prega cutânea tricipital, supra-ilíaca e coxa, além dos cálculos de IMC e percentual de gordura corporal através do programa EVO®. <strong>Resultados - </strong>Foi observado que apenas 25,95% das mulheres eutróficas pelo valor do IMC permaneceram com mesmo diagnóstico nutricional após avaliação do percentual de gordura corporal. A prevalência de obesidade, segundo o IMC, foi de 6,37% da amostra total, enquanto essa prevalência entre mulheres eutróficas pelo IMC, após avaliação da composição corporal, foi de 38,17%, 6 vezes maior. Observou-se, também, influência da idade na adequação do IMC e percentual de gordura corporal. <strong>Discussão </strong>- Os achados deste estudo foram compatíveis com outros resultados encontrados na literatura, sugerindo subdiagnóstico do sobrepeso e da obesidade através da classificação do IMC e a necessidade da associação de métodos para uma avaliação clínica mais adequada e um diagnóstico do estado nutricional mais preciso.</span></p> <p class="MsoNormal" style="margin: 0cm 22.7pt 0.0001pt; text-align: justify;"><strong></strong><span style="font-size: 8pt;"></span><span style="font-size: 8pt;" lang="EN-US"></span></p> <p class="MsoNormal" style="margin: 0cm 22.7pt 0.0001pt; text-align: justify;"><strong><span style="font-size: 8pt; color: black;" lang="EN-US"> </span></strong></p> <p class="MsoNormal" style="margin: 0cm 22.7pt 0.0001pt; text-align: justify;"><strong><span style="font-size: 8pt; color: black;" lang="EN-US">Abstract</span></strong></p> <p class="MsoNormal" style="margin: 0cm 22.7pt 0.0001pt; text-align: justify;"><strong><span style="font-size: 8pt; color: black;" lang="EN-US">Introduction</span></strong><span style="font-size: 8pt;" lang="EN-US">: The BMI (Body Mass Index) is the major parameter currently recommended by the WHO (world health organization) to determine the diagnosis and the treatment to obesity and overweight. The intermediate BMI classification could underestimate the diagnosis when is compared with other evaluation methods. <strong>Methods</strong>: the aim of this paper is show the relationship between normal BMI and the high percentage body fat evaluated by skin fold thicknesses protocol (Pollock, 1984) in woman from Salvador, Bahia, Brazil in 2010. We compared the classification diagnosis based in BMI and skin fold thicknesses in 204 women age between 20 to 59 years. <strong>Results</strong>: in our sample, according with the classification based in BMI 74% of subjects was considered normal weight. When we analyzed the skin fold classification only 26% remain with the same diagnosis. <strong>Conclusions</strong>: Our outcome shows the role of the BMI in the diagnosis of the obesity and overweight must to be considerated and added to other methods of evaluation of the body compositions a skin fold protocols.</span></p>


2021 ◽  
Vol 9 (40) ◽  
pp. 37-46
Author(s):  
Medha Ghose ◽  
Maehali Patel

On March 11, 2020, the World Health Organization (WHO) released a statement characterizing COVID-19 as a pandemic that has, as of October 2020, caused almost 36 million confirmed global cases and over 1 million deaths. One of the long-term complications suggested by researchers is fibrosis. It has been hypothesized that the combination of ongoing pulmonary injury caused by COVID-19 and the inability to promptly repair damage results in interstitial matrix widening and eventual compression and destruction of alveoli and capillaries. Here we focus on pathogenesis, risk factors, different infectious causes of fibrosis along with COVID-19, and potential treatment options that might reduce its effects. Key words: COVID-19, pulmonary fibrosis, mechanism, treatment


2021 ◽  
pp. bmjsrh-2021-201242
Author(s):  
Rebecca Blaylock ◽  
Shelly Makleff ◽  
Katherine C Whitehouse ◽  
Patricia A Lohr

IntroductionThe National Institute for Health and Care Excellence, the Royal College of Obstetricians and Gynaecologists and the World Health Organization recommend that services provide a choice between medical and surgical methods of abortion. We analysed qualitative study data to examine patient perspectives on abortion method choice and barriers to meeting them.MethodsIn-depth interviews with 24 clients who had an abortion at British Pregnancy Advisory Service clinics were carried out between December 2018 and July 2019 to examine perspectives of quality of abortion care. In this article we focus on client perspectives on choice of abortion method. We performed thematic analysis of data relating to choice of abortion method, refined the analysis, interpreted the findings, and organised the data into themes.ResultsParticipants’ preferences for abortion method were shaped by prior experience of abortion, accessibility and privacy, perceptions of risk and experiences of abortion method, and information gathering and counselling. Participants’ ability to obtain their preferred method was impacted by intersecting constraints such as appointment availability, service location and gestational age.ConclusionsOur findings show that many factors shape participants’ preferences for abortion method. In response to the COVID-19 pandemic, some abortion services have constrained abortion method choices, with an emphasis on medical abortion and ‘no-touch’ care. Providers in the UK and beyond should aim to restore and expand more treatment options when the situation allows.


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