scholarly journals Endoscopic Revision (StomaphyX) versus Formal Surgical Revision (Gastric Bypass) for Failed Vertical Band Gastroplasty

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Johan Bolton ◽  
Richdeep S. Gill ◽  
Akram Al-Jahdali ◽  
Simon Byrns ◽  
Xinzhe Shi ◽  
...  
Keyword(s):  
Weight Regain ◽  
Vertical Band Gastroplasty ◽  
Complication Rates ◽  
Safe Alternative ◽  
Post Procedure ◽  
Pouch Dilation ◽  
Technical Modifications ◽  
Endoscopic Revision

Background. Weight regain secondary to VBG pouch dilation is a typical referral for Bariatric surgeons. In this study we compare an endoluminal pouch reduction (Stomaphyx) to RYGB for revision.Methods. A retrospective review was completed for patients with a previous VBG presenting with weight regain between 2003–2010.Results. Thirty patients were identified for study 23 RYGB, 14 StomaphyX. Significant post procedure BMI loss was seen in each cohort (RYGB,47.7 ± 7 kg/m2to35 ± 7 kg/m2; StomaphyX43 ± 10 kg/m2to40 ± 9 kg/m2,P=0.0007). Whereas nausea and headache were the only complications observed in StomaphyX patients, the RYGB group had a 43.5% complication rate and 1 mortality. Complications following RYGB include: incisional hernia (13%), anastomotic leak (8.7%), respiratory failure (8.7%), fistula (8.7%), and perforation (4.35%). The median length of stay following RYGB was 6 days compared to1.5 ± 0.5days following StomaphyX.Conclusion. This study suggests that while RYGB revision may achieve greater weight loss, the complication rates and severity is discouraging. StomaphyX may be a safe alternative. Further technical modifications of the device and longer follow-up may clarify the role of this approach.

Post procedure

2020 ◽  
pp. 315-322
Author(s):  
Andrew Mitchell ◽  
Giovanni Luigi De Maria ◽  
Adrian Banning
Keyword(s):  
Discharge Summary ◽  
Specialist Nurse ◽  
Post Procedure

This chapter covers the actions required after the patient has undergone their procedure. It begins by explaining the role of the specialist nurse team, the checks that should be performed on the patient once they have returned to the ward, and the process for becoming ambulant. The chapter then goes on to explain how to review the results and data regarding the case. Communication of both results and potential follow-up procedures is then covered. The chapter ends by addressing discharge plans and guidance is given on completing a discharge summary.

scholarly journals Independent assessment and outcomes of 196 short-tapered stems short-term follow-up and review of the literature

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901881223 ◽  
Author(s):  
Sam Nahas ◽  
Akash Patel ◽  
Nicola Blucher ◽  
Vikas Vedi
Keyword(s):  
Outcome Measures ◽  
Case Series ◽  
Outcome Data ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Short Term ◽  
Safe Alternative ◽  
Term Outcome ◽  
Patient Reported

Background: Longer term outcome data are now becoming available for short-tapered femoral stems for cementless total hip arthroplasty. The shorter stem has a metaphyseal fit, loading the bone in this area, leading to physiological bone remodelling. It is also bone preserving, as it is 35 mm shorter. It may be easier to insert through a smaller incision and potentially reduce complication rates. We present a retrospective single surgeon case series of 196 patients (>53% follow-up over 5 years). All patients had the cementless ‘Microplasty Taperloc’ (Biomet). Primary outcome measures were femoral component revision rates. Secondary outcome measures included complications, patient-reported functional outcome scores (Oxford hip) and radiographic evidence of loosening. Methods: Patients were identified using electronic software. All were routinely followed up and assessed in clinic since implant introduction in 2009. Oxford hip scores were routinely obtained. A surgeon who had not carried out the procedure independently assessed radiographs. Results: One hundred ninety-six patients were identified. The revision rate was 0.5% due to an intraoperative peri-prosthetic fracture of the femur identified on post-operative radiograph. The complication rate was 2%, attributable to: subsidence of the prosthesis (one hip), post-operative dislocation (two hips), one of which required acetabular revision. Oxford hip scores increased on average from 21 to 45 (pre- to post-operatively). There were no signs of radiographic loosening. Conclusion: The results show that using the short-tapered stem is proving so far to be a reliable and safe alternative to its longer counterpart, with low complication rates in the short term.

scholarly journals Is secondary achalasia a reality? Primary versus secondary achalasia: Role of barium swallow

2016 ◽  
Vol 9 (4) ◽  
Author(s):  
Khawaja Khurshid Ahmad ◽  
Asim Shaukat ◽  
Muhammad Ali ◽  
Yasser Amin ◽  
Tahir Qadeer ◽  
...  
Keyword(s):  
Endoscopic Biopsy ◽  
Barium Swallow ◽  
Lower Esophagus ◽  
Post Procedure ◽  
Secondary Achalasia

This study was conducted in the Department of Radiology Mayo Hospital, Lahore from January 2002 to December 2002. 30 Patients with findings on barium swallow of Achalasia were taken. Post procedure follow up was carried out either in the shape of endoscopic biopsy or post operative biopsy. The results showed that 25 out of 30 had Primary Achalasia and 5 had Secondary Achalasia. The results were compared with age of the patients and it was found that Secondary Achalasia, which was due to carcinoma of the lower esophagus or fundus of stomach, was virtually non existent before the age of 30. These were 5 patients all above 30 years of age.

Post-Procedure CT Follow-up after Percutaneous Automated Lumbar Nucleotomy

1996 ◽  
Vol 2 (4) ◽  
pp. 283-286 ◽  
Author(s):  
R. Dullerud ◽  
J.G. Johansen
Keyword(s):  
Cohort Study ◽  
Clinical Symptoms ◽  
Subcutaneous Fat ◽  
Psoas Muscle ◽  
Ct Scans ◽  
Complication Rates ◽  
Post Procedure ◽  
Tissue Changes ◽  
Soft Tissue Changes

In order to evaluate the incidence of soft tissue changes after automated lumbar nucleotomy, a prospective cohort study was performed with follow-up CT within four to six hours after treatment of 97 discs in 88 patients. The CT scans were normal at 47 levels and abnormal at 50. At 11 levels traces of blood were seen along the trajectory, of which nine were located in the subcutaneous fat, one in the extensor and one in the psoas muscle. Small gas collections were observed at 42 levels. Twenty-one of them were located in the extensor and two in the psoas muscle, seven in the subcutaneous fat, two in the epidural space and ten in multiple locations. The abnormal scans were not associated with clinical symptoms different from those with normal scans. The results support previous reports indicating that this procedure is associated with low morbidity and complication rates.

scholarly journals Role of No Hydro Phacoemulsification Technique in Management of Posterior Polar Cataract

2020 ◽  
Vol 3 (10) ◽  
pp. 707-711
Author(s):  
Dr. Gaurav Paranjpe ◽  
Dr. Rohini Sangoram ◽  
Dr. Devika Damle
Keyword(s):  
Cataract Surgery ◽  
Medical Records ◽  
Posterior Capsule ◽  
Corrected Visual Acuity ◽  
Posterior Capsule Rupture ◽  
Technical Modifications ◽  
Capsule Rupture ◽  
Posterior Polar Cataract

    Posterior polar cataracts (PPC) have always been a challenge for cataract surgeons due to their inherently higher propensity for posterior capsule rupture. Over the years, several technical modifications in cataract surgery  have been suggested to enhance safety and reduce the percentage of  posterior capsule rupture rates in these posterior  polar cataracts. This retrospective study  tries to present  the role and  complications of no hydro phacoemulsification technique in management of posterior polar cataract. Aim: To evaluate the role of prehydro phacoemulsification and partial depth phacoemulsification with hydrodelineation in posterior polar cataract (PPC). Method: Medical records of 100 patients with clinical diagnosis of PPC, who underwent pre hydro phacoemulsification and partial depth phacoemulsification with hydrodelineation, were retrospectively reviewed. Results: The incidence of posterior capsule rupture (PCR) was 8% (8/100): 4 cases occurred during epinucleus removal, 3 cases occurred during IOL implantation, and 1 occurred during OVD removal after the implantation of the intraocular lens into the bag. No nucleus piece or lens materials dropped into the vitreous during cataract surgery, and no obvious postoperative complications were found during follow-up. All patients had improved best-corrected visual acuity (BCVA) 1 month postoperatively. Conclusion: Pre hydro phacoemulsification and partial depth phacoemulsification with hydrodelineation help to reduce the incidence of PCR and achieve satisfactory postoperative outcomes.

Y-Stenting Versus PulseRider-Assisted Coiling in the Treatment of Wide-Neck Bifurcation Aneurysms: Role of Anatomical Features on Midterm Results

Neurosurgery ◽  
2019 ◽  
Vol 87 (2) ◽  
pp. 329-337 ◽  
Author(s):  
Nicola Limbucci ◽  
Carlo Cirelli ◽  
Iacopo Valente ◽  
Sergio Nappini ◽  
Leonardo Renieri ◽  
...  
Keyword(s):  
Complication Rates ◽  
Anatomical Features ◽  
Neck Size ◽  
New Device ◽  
Aneurysm Size ◽  
Occlusion Rate ◽  
Middle Cerebral Artery Aneurysms ◽  
Wide Neck

Abstract BACKGROUND Y-stenting is an effective but challenging approach for wide-neck aneurysms. PulseRider (PR) (Pulsar/Cerenovus) is a new device designed to provide scaffolding during coiling but has never been compared with other techniques. OBJECTIVE To compare the immediate and 6-mo results of Y-stenting vs PR assisted coiling. METHODS A total of 105 consecutive patients were retrospectively divided into 2 groups (73 Y-stenting and 32 PR). All underwent angiographic 6-mo follow-up. We evaluated if some anatomical features could influence treatment results. RESULTS The groups were homogeneous. Immediate adequate occlusions as well as complication rates were similar in Y-stenting and PR group (94.5% vs 96.9% and 8.2% vs 6.2%, respectively). At 6 mo, adequate occlusion was 93.1% after Y-stenting and 84.3% after PR (P = .28), complete occlusion was significantly higher after Y-stenting: 90.3% vs 62.5% (P = .0017). Occlusion grade worsening occurred in 6.9% of Y-stenting and 18.7% of PR patients (P = .09). Neck size was associated with occlusion grade in both groups. Maximal aneurysm size was associated with occlusion grade in the PR group (P = .023) but not in the Y-stenting group (P = .06). After PR, 6-mo occlusion rate was higher in small (< 10 mm) than in large aneurysms (P = .0094); this was not observed after Y-stenting (P = .54). Location did not significantly affect the mid-term occlusion rate in both the groups. After PR, occlusion was more stable in basilar than anterior or middle cerebral artery aneurysms. CONCLUSION Y-stenting and PR are both effective with similar immediate and mid-term results. However, treatment stability seems higher after Y-stenting. Aneurysm size seems to negatively affect PR results.

Silastic Duraplasty in Pediatric Patients

Neurosurgery ◽  
1991 ◽  
Vol 29 (5) ◽  
pp. 785-788 ◽  
Author(s):  
Frederick A. Boop ◽  
William M. Chadduck
Keyword(s):  
Surgical Technique ◽  
Spinal Dysraphism ◽  
Late Complications ◽  
Magnetic Resonance Imaging Scan ◽  
Neural Tissues ◽  
Technical Modifications ◽  
Chiari Ii ◽  
Graft Removal

Abstract The role of adhesions in the retethering of the neural elements after surgical treatment of spinal dysraphism has produced refinements in the technique of the closure of the neural tube. Silastic. because of its relative inert property. has been used for duraplasty. but a few reports of late complications of hemorrhage or fibrotic capsule formation have caused concern over its use. We report 33 patients with the following diagnoses-eight spinal lipomyelomeningoceles. three myelomeningoceles. six symptomatic Chiari II malformations, seven tethered cords, six spinal cord tumors, two diastematomyelia. and one cerebellar astrocytoma-in whom Silastic dural grafts were used to prevent the adherence of neural structures to the overlying tissues. Our surgical technique is presented here. The patients have been observed for up to 6 years. Only one became infected, was treated with antibiotics without graft removal, and has remained without sequelae for over 3 years. One had an incidental pseudomeningocele that was noted on follow-up magnetic resonance imaging scan that was not clinically apparent. There have been no hemorrhages. leakage of cerebrospinal fluid. nor other complications from using nonreinforced Silastic sheeting. In one patient. Dacron-reinforced Silastic was used and. upon reexploration. a marked fibroblastic response was noted. A review of the literature suggests that fibrotic complications are related to this Dacron-reinforced Silastic. The hemorrhagic complications that were reported occurred in instances where Silastic grafts were large and no technical modifications were made preventively. We conclude that the use of nonreinforced Silastic dural grafts, with appropriate technical modifications in surgical technique, is safe and may prevent retethering of neural tissues in a variety of neurosurgical lesions.

scholarly journals Metabolic adaptation is an illusion, only present when participants are in negative energy balance

2020 ◽  
Vol 112 (5) ◽  
pp. 1212-1218 ◽  
Author(s):  
Catia Martins ◽  
Jessica Roekenes ◽  
Saideh Salamati ◽  
Barbara A Gower ◽  
Gary R Hunter
Keyword(s):  
Weight Loss ◽  
Energy Balance ◽  
Weight Regain ◽  
Resting Metabolic Rate ◽  
Negative Energy ◽  
Metabolic Adaptation ◽  
Initial Weight Loss ◽  
Maintenance Program

ABSTRACT Background The existence of metabolic adaptation, following weight loss, remains a controversial issue. To our knowledge, no study has evaluated the role of energy balance (EB) in modulating metabolic adaptation. Objectives The aim of this study was to determine if metabolic adaptation, at the level of resting metabolic rate (RMR), is modulated by participants’ EB status. A secondary aim was to investigate if metabolic adaptation was associated with weight regain. Methods Seventy-one individuals with obesity (BMI: 34.6 ± 3.4 kg/m2; age: 45.4 ± 8.2 y; 33 men) enrolled in a 1000-kcal/d diet for 8 wk, followed by 4 wk of weight stabilization and a 9-mo weight loss maintenance program. Body weight/composition and RMR were measured at baseline, week 9 (W9), week 13 (W13), and 1 y (1Y). Metabolic adaptation was defined as a significantly different (lower or higher) measured compared with predicted RMR. Results Participants lost on average 14 kg by W9, followed by weight stabilization at W13, and regained 29% of their initial weight loss at 1Y. Metabolic adaptation was found at W9 (−92 ± 110 kcal/d, P < 0.001) and W13 (−38 ± 124 kcal/d, P = 0.011) but was not correlated with weight regain. A significant reduction in metabolic adaptation was seen between W9 and W13 (−53 ± 101 kcal/d, P < 0.001). In a subset of participants who gained weight between W9 and W13 (n = 33), no metabolic adaptation was seen at W13 (−26.8 ± 121.5 kcal/d, P = 0.214). In a subset of participants with data at all time points (n = 45), metabolic adaptation was present at W9 and W13 (−107 ± 102 kcal/d, P < 0.001 and −49 ± 128 kcal/d, P = 0.013) but not at 1Y (−7 ± 129, P = 0.701). Conclusion After weight loss, metabolic adaptation at the level of RMR is dependent on the EB status of the participants, being reduced to half after a period of weight stabilization. Moreover, metabolic adaptation does not predict weight regain at 1Y follow-up. These trials were registered at clinicaltrials.gov as NCT02944253 and NCT03287726.

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