Excess Body Weight and Abdominal Hernia

Background: Obese patients have an increased incidence of ventral hernias; in over 50% of these cases, patients are symptomatic. At the same time, morbid obesity is a disease of epidemic proportions. The combination of symptomatic hernia and obesity is a challenge for the treating surgeon, because the risk of perioperative complications and recurrence increases with increasing BMI. Summary: This review outlines this problem and discusses interdisciplinary approaches to the management of affected patients. In emergency cases, the hernia is treated according to the surgeon’s expertise. In elective cases, an individual decision must be made whether bariatric surgery is indicated before hernia repair or whether both should be performed simultaneously. After bariatric surgery a weight reduction of 25–30% of total body weight in the first year can be achieved and it is often advantageous to perform a bariatric operation prior to hernia repair. Technically, the risk of complications is lower with minimally invasive procedures than with open ones, but laparoscopy is challenging in obese patients, and meshes can only be implanted in intraperitoneal position. This mesh position has to be questioned because of adhesions, recurrence rate, and risk of contamination during re-interventions in patients who are often still relatively young. Key Messages: Obese patients with hernia need to be approached in an interdisciplinary manner, in some patients a weight loss procedure may be advantageous before hernia repair. Recent data show the benefits of robotic hernia surgery in obese patients, as not only haptic advantages result, but especially the mesh can be implanted in a variety of extraperitoneal positions in the abdominal wall with low morbidity.

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IV fosphenytoin in obese patients

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000322 ◽

2016 ◽

Vol 7 (1) ◽

pp. 45-52 ◽

Cited By ~ 2

Author(s):

Sarah L. Clark ◽

Megan R. Leloux ◽

Ross A. Dierkhising ◽

Gregory D. Cascino ◽

Sara E. Hocker

Keyword(s):

Body Weight ◽

Adverse Events ◽

Vital Signs ◽

Drug Distribution ◽

Retrospective Chart Review ◽

Current Method ◽

Liver Function Tests ◽

Excess Body Weight ◽

Obese Patients ◽

Bonferroni Adjustment

AbstractBackground:Previous studies evaluated the disposition of IV phenytoin loading doses and found that obese patients had increased drug distribution into excess body weight, larger volumes of distribution, and longer half-lives when compared to their nonobese counterparts. We assess the safety and efficacy of fosphenytoin loading doses in patients with different body mass indices (BMIs).Methods:A retrospective chart review was conducted in 410 patients who received fosphenytoin. Patients were divided into 2 groups: BMI <30 (nonobese) and BMI ≥30 (obese). Patient demographics, fosphenytoin dose administered in mg/kg body weight, renal and liver function tests, fosphenytoin drug levels, and pre- and post-fosphenytoin administration vital signs were collected to assess for adverse events. Necessity of additional antiepileptic loading doses was used as a surrogate for clinical efficacy.Results:The median dose of fosphenytoin administered was 19 mg/kg (interquartile range 15–20). The most frequently encountered adverse event was hypotension, which occurred in 39% of the cohort. Using a Bonferroni adjustment for multiple comparisons, there were no differences in adverse events between the 2 groups. The need for additional antiepileptic loading doses was not different between the 2 groups (p = 0.07).Conclusions:The incidence of adverse events and the need for repeat loading antiepileptic medications was similar between the 2 groups. From our findings, the patients in our study did not receive empiric loading dose adjustments and the current method of loading fosphenytoin achieves similar outcomes, regardless of the patient's BMI.

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Comment on: Ventral hernia surgery in morbidly obese patients, immediate or after bariatric surgery preparation: Results of a case-matched study

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2018.10.023 ◽

2019 ◽

Vol 15 (1) ◽

pp. 88-90

Author(s):

Cynthia-Michelle Borg

Keyword(s):

Bariatric Surgery ◽

Ventral Hernia ◽

Morbidly Obese ◽

Obese Patients ◽

Hernia Surgery ◽

Matched Study

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Mechanical modelling of the human abdomen following hernia surgery

Jornada de Jóvenes Investigadores del I3A ◽

10.26754/jji-i3a.201401734 ◽

1970 ◽

Vol 1 ◽

pp. 14-15

Author(s):

Belén Hernández Gascón ◽

Estefanía Peña Baquedano ◽

Gemma Pascual González ◽

Juan M. Bellón ◽

Begoña Calvo

Keyword(s):

Hernia Repair ◽

Experimental Techniques ◽

Abdominal Hernia ◽

Hernia Surgery ◽

Mechanical Modelling ◽

Computational Methodology

Abdominal hernia is a frequent disease and diverse problems following hernia repair could reduce the quality of patient life. This work is projected to define a computational methodology based on experimental techniques that would help surgeons in deciding which prosthesis is the most convenient depending on the type of defect and patient.

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An analysis of the objective and subjective evaluation of the results of surgical treatment of morbid obesity

Obesity and metabolism ◽

10.14341/omet2015326-30 ◽

2015 ◽

Vol 12 (3) ◽

pp. 26-30

Author(s):

Valeriy Nikolaevich Egiev ◽

Yuliya Borisovna Mayorova ◽

Evgeniy Aleksandrovich Zorin ◽

Anastasiya Vladimirovna Мелеshko ◽

Ekaterina Sergeevna Orlovskaya

Keyword(s):

Bariatric Surgery ◽

Morbid Obesity ◽

Body Weight ◽

Surgical Treatment ◽

Treatment Effectiveness ◽

Minimum Weight ◽

Subjective Evaluation ◽

Objective Assessment ◽

Subjective Assessment ◽

Excess Body Weight

The results of surgical treatment of morbid obesity usually considers a variety of factors and the main attention is paid to the dynamics of body weight after surgery. It is generally accepted that in the absence of reducing excess body weight or with minimum weight loss (a few kilograms), the result is considered unsatisfactory. The aim of the work was to compare an objective assessment of gastric bypass (GBS) and gastric banding (GB) and the subjective evaluation of treatment effectiveness by patients themselves. The study included 457 (69.7%) patients that underwent GB and 198 (30.3%) patients after GBS. At the late postoperative period 243 patients (53.2%) were available after the GB and 112 (56.6%) patients after GBS. The frequency of matches between objective and subjective assessment of outcomes of surgery usually did not exceed 50%. Given this, there is a need for a comprehensive analysis of the results of bariatric surgery. Developed multicomponent scale allows to evaluate the effectiveness of any bariatric surgery.

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Ventral hernia surgery in morbidly obese patients, immediate or after bariatric surgery preparation: Results of a case-matched study

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2018.09.490 ◽

2019 ◽

Vol 15 (1) ◽

pp. 83-88 ◽

Cited By ~ 7

Author(s):

Marie-Maëlle Chandeze ◽

David Moszkowicz ◽

Alain Beauchet ◽

Karina Vychnevskaia ◽

Frédérique Peschaud ◽

...

Keyword(s):

Bariatric Surgery ◽

Ventral Hernia ◽

Morbidly Obese ◽

Obese Patients ◽

Hernia Surgery ◽

Matched Study

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The Effective Effect-Site Propofol Concentration for Induction in Morbidly Obese Patients Using Total Body Weight with a New Pharmacokinetic Model

Anesthesia & Analgesia ◽

10.1213/ane.0b013e318290c7d8 ◽

2013 ◽

Vol 117 (1) ◽

pp. 283-284 ◽

Cited By ~ 3

Author(s):

Natalia F. de la Fuente ◽

Valentina A. Puga ◽

Luis I. Cortínez ◽

Hernán R. Muñoz

Keyword(s):

Body Weight ◽

Pharmacokinetic Model ◽

Total Body Weight ◽

Morbidly Obese ◽

Obese Patients ◽

Effect Site ◽

Total Body

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P0264ASSESSMENT OF GFR IN MORBIDLY OBESE PATIENTS USING DIFFERENT EQUATIONS: WHICH IS THE BEST?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0264 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Alaa Sabry ◽

Amir Basiony ◽

Mohamed Kamal

Keyword(s):

Body Weight ◽

Creatinine Clearance ◽

Glomerular Filtration ◽

Total Body Weight ◽

Lean Body Weight ◽

Morbidly Obese ◽

Obese Patients ◽

Morbidly Obese Patient ◽

Gault Formula ◽

Total Body

Abstract Background and Aims Obesity is a potent risk factor for the development of kidney disease. The prevalence of abdominal obesity in Egyptians based upon the European cut-off points was 30.2% for men and 70.9% for women. To detect the best formula for estimation of glomerular filtration rates in morbidly obese individuals. Method: In this prospective study 82 morbidly obese patients were included, Age: 15 to 65 years, Morbidly obese patient (BMI > 40 Kg/m2), Creatinine clearance calculated from a 24-h urine was done, Estimated glomerular filtration rate (eGFR): It was assessed to be correlated with creatinine clearance and detect the most suitable formula for morbidly obese patients. Cockcroft-Gault formula: Cockcroft-Gault formula (for total body weight): ockcroft-Gault formula (for adjusted body weight): Cockcroft-Gault formula (for lean body weight), MDRD-eGFR (Modification of Diet in Renal Disease equation) (Shahbaz & Gupta, 2019), CKD-epidemiology (CKD-EPI): (Levey, et al, 2009) Results Demogrphic criteria of the studdied patients Conclusion: The equations that had the nearest values to creatinine clearance were CG-TBW-GFR and CGAjBW- GFR, both of them had a moderate reliability with more agreement for the CG-TBW-GFR equation . The CG-TBW-GFR formula was the most reliable one to measure GFR, followed by the CG-AjBW-GFR formula, while the CG-IBW, CG-LBW, MDRD-GFR and CKD-EPI-GFR formulae were not reliable at all .

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Anaesthetists’ drug dosing practices in class III obese surgical patients: A bi-national survey

Anaesthesia and Intensive Care ◽

10.1177/0310057x19886596 ◽

2019 ◽

Vol 47 (6) ◽

pp. 516-521

Author(s):

Zahid Hussain ◽

Karl Gadd ◽

Colin Curtain ◽

Corinne Mirkazemi ◽

Gregory M Peterson ◽

...

Keyword(s):

Body Weight ◽

New Zealand ◽

Adverse Events ◽

Total Body Weight ◽

Surgical Patients ◽

Lean Body Weight ◽

Obese Patients ◽

Class Iii ◽

Drug Dosing ◽

Zealand College

Class III obese (body mass index ≥ 40 kg/m2) patients, now regularly encountered clinically, have increased perioperative risks, including potentially from suboptimal drug dosing. However, current dosing guidelines are based on low-level evidence and may not be widely accepted. This study aimed to investigate anaesthetists’ dosing practices for class III obese surgical patients, explore if they had experienced an increased incidence of adverse events potentially related to drug dosing with these patients and assess which resources they consulted for dosing advice in this population. An electronic survey was emailed to 1000 randomly selected members of the Australian and New Zealand College of Anaesthetists. Data were summarised and the Pearson’s χ2 test was used to compare respondents’ genders, geographic locations and seniority designations with the greater Australian and New Zealand College of Anaesthetists’ membership. There were 230 completed responses (response rate 23%). A large proportion (46%–76%) of respondents indicated they dose class III obese patients in keeping with current recommendations; however, substantial heterogeneity in dosing practices was found. Lean body weight was the most frequently used regimen for dosing propofol, non-depolarising muscle relaxants, sugammadex and opioids, whereas total body weight was most frequently used for suxamethonium. Nearly 70% of respondents reported using at least one resource to assist their dosing practices in obesity. Importantly, increased incidences of adverse events in class III obese patients related to drug dosing were commonly experienced by respondents. Until higher-level evidence is available for dosing class III obese patients, anaesthetists should consider current recommendations and exercise increased attention to dosing. Further clinician education may assist in optimising dosing in this patient group.

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