scholarly journals Omentopexy with Glubran®2 for reducing complications after laparoscopic sleeve gastrectomy: results of a randomized controlled study

BMC Surgery ◽  
2019 ◽  
Vol 19 (S1) ◽  
Author(s):  
Vincenzo Pilone ◽  
Salvatore Tramontano ◽  
Michele Renzulli ◽  
Mafalda Romano ◽  
Angela Monda ◽  
...  

Abstract Background Gastric fistulas, bleeding, and strictures are commonly reported after laparoscopic sleeve gastrectomy (LSG), that increase morbidity and hospital stay and may put the patient’s life at risk. We report our prospective evaluation of application of synthetic sealant, a modified cyanoacrylate (Glubran®2), on suture rime, associated with omentopexy, to identify results on LSG-related complications. Methods Patients were enrolled for LSG by two Bariatric Centers, with high-level activity volume. Intraoperative recorded parameters were: operative time, estimated intraoperative bleeding, conversion rate. We prospectively evaluated the presence of early complications after LSG during the follow up period. Overall complications were analyzed. Perioperative data and weight loss were also evaluated. A control group was identified for the study. Results Group A (treated with omentopexy with Glubran®2) included 96 cases. Control group included 90 consecutive patients. There were no differences among group in terms of age, sex and Body Mass Index (BMI). No patient was lost to follow-up for both groups. Overall complication rate was significantly reduced in Group A. Mean operative time and estimated bleeding did not differ from control group. We observed three postoperative leaks in Group B, while no case in Group A (not statistical significancy). We did not observe any mortality, neither reoperation. Weight loss of the cohort was similar among groups. In our series, no leaks occurred applying omentopexy with Glubran®2. Conclusion Our experience of omentopexy with a modified cyanoacrylate sealant may lead to a standardized and reproducible approach that can be safeguard for long LSG-suture rime. Trial registration Retrospective registration on clinicaltrials.gov PRS, with TRN NCT03833232 (14/02/2019).

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Paolo Gentileschi ◽  
Emanuela Bianciardi ◽  
Leandro Siragusa ◽  
Valeria Tognoni ◽  
Domenico Benavoli ◽  
...  

Background. Weight regain after laparoscopic sleeve gastrectomy (LSG) is nowadays a growing concern. Sleeve dilatation and loss of food restriction is considered the main mechanism. The placement of a silicon ring around the gastric tube seems to give benefits in the short term. We report the results of a randomized study comparing LSG and laparoscopic banded sleeve gastrectomy (LBSG) over a 4-year follow-up. Objectives. To evaluate the efficacy of banded sleeve gastrectomy compared to standard sleeve in the midterm. Methods. Between 01/2014 and 01/2015, we randomly assigned 50 patients to receive one of the two procedures. Patients’ management was exactly the same, apart from the band placement. We analyzed differences in weight loss, operative time, complication rate, and mortality, with a median follow-up of 4 years. Results. Twenty five patients were assigned to receive LSG (Group A) and 25 LBSG (Group B). The mean preoperative BMI (body mass index) was 47.3 ± 6.58 kg/m2 and 45.95 ± 5.85 kg/m2, respectively. There was no significant difference in the operative time. No intraoperative or postoperative complications occurred. At 12-month follow-up, the mean BMI was 29.72 ± 4.40 kg/m2 in Group A and 27.42 ± 4.47 kg/m2 in Group B (p=0.186). After a median follow-up of 4 years, the mean BMI in Group B was significantly lower than Group A (24.10 ± 4.52 kg/m2 vs 28.80 ± 4.62 kg/m2; p=0.00199). Conclusions. LBSG is a safe procedure, with no impact on postoperative complications. The banded sleeve showed a significant greater weight loss in the midterm follow-up. Considering the issue of weight regain observed after LSG, the placement of a perigastric ring during the first procedure may be a strategy to improve the results. This trial is registered with NCT04228185.


2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Andrea Balla ◽  
Silvia Quaresima ◽  
Pietro Ursi ◽  
Ardit Seitaj ◽  
Livia Palmieri ◽  
...  

Introduction. In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods. Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results. At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p=0.006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p=0.837) postoperatively became 9.5 and 2.4 (p=0.071). In group A, there was no difference between pre- and postoperative scores (p=0.279), whereas in group B, a highly significant difference was observed (p=0.002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p=0.0058). Conclusions. In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG.


Author(s):  
Sabir Ali ◽  
Renu Rathi ◽  
Bharat Rathi

Background: Kasa is the outcome due to release of obstructed Vayu resulting in the production of abnormal sound, which may be productive or dry. Kasa is one of the primary diseases of Pranavaha srotas, and can cause disturbances in other body functions. Prevalence of cough in India is 5% to 10% while acute cases of cough is 39% and chronic cases of cough is 29% reported in Maharashtra. This research drug is taken to check its efficacy on both the types of cough, dry as well as productive with acute or chronic origin. It has a good palatability and liked by children as it appears as candy. Many studies have been carried out on Kasa with different formulations so far like vati, churna, ghrita but they have no fast and long lasting action with different level of efficacy. Many lozenges are also available in the market but no studies have been done. Objective: Comparative Study on the efficacy of Kantakari lozenges with Vasa lozenges in the clinical features of Kasa by subjective criteria such as Peenasa-(running nose), Kasa, Aruchi-(taste impliedness), kanthkandu(throat itching), kaphnishthivan (Sputum) and objective criteria as adventitious sound and AEC-absolute eosinophil count, TLC-total leucocytes count, and DLC-differential leucocyte count. Materials and Methods: The present study is designed as a Double Blind, Randomized Controlled Study in which total 60 patients will be enrolled. Patients will be randomly divided (by computer generated sequence method) in two with 30 patients in each group. In group A, Vasa lozenges and in group B Kantkari lozenges will be given for 7 days. Assessment of the patients will be done on 3rd and 7th day during study after intervention and post treatment follow up will be taken on 14th& 21st day from the enrolled date. Results: Efficacy of both the lozenges will be observed in subjective and objective outcomes. Conclusion: Kantkari lozenges (trial group) is expected to be more effective than Vasa lozenges (control group) in the management of Kasa as Vata, Kapha are more dominant in the pathology of Kasa in children and Kantakari is a good Vatakaphahar drug added with Pippali to act synergistically.


2012 ◽  
Vol 30 (5_suppl) ◽  
pp. LBA266-LBA266
Author(s):  
Takashi Saika ◽  
Tomoyasu Tsushima ◽  
Yasutomo Nasu ◽  
Hiromi Kumon ◽  

LBA266 Background: Although single intravesical instillation chemotherapy immediately after transurethral resection (TUR) is the standard treatment for non-muscle-invasive bladder tumors, 40% to 80% of tumors show intravesical recurrence. In this prospective randomized controlled study, we try to evaluate the prophylactic efficacy and safety of twice intravesical instillation using pirarubicin (THP) administered immediately after TUR and on the next day following TUR by comparison with single instillation immediately after TUR. Methods: Between 2005 and 2009, 250 patients with Ta and T1 solitary bladder carcinoma were enrolled in this study. Patients were randomized into two groups. Group A patients were treated with two intravesical instillations of THP 30 mg/50 ml saline immediately after TUR and within 24 hours. Group B patients were treated with single instillation of the same dose immediately after TUR as a control group. The primary endpoint was duration to the first recurrence, and the secondary endpoint was safety. Results: The enrollment was closed on 2009, and the follow-up phase is in process. Of the 250 patients, 125 in Group A and 125 in Group B could be evaluated as full analysis set. One hundred eight male and 17 female were in Group A, on the other hands, one hundred five male and 20 female were in Group B. Eighty-six cases (69%) in group A, and 88 cases (70%) in group B were primary tumor. Fifty-seven cases (46%) in group A, and 56 cases (45%) in group B were small tumor (less than 10mm). There was no difference between backgrounds of both groups. The randomization worked well. In this ad interim report, median follow up was 48 months. Two-year recurrence-free rates were 76.8% in group A and 67.5% in group B. Adverse reactions related to instillation were observed in about 20% of the patients. These toxicities were mild and transient. Only the incidence of frequency in group A was higher than that in group B (20% vs. 8%, p=0.0106). Conclusions: Intravesical instillation of THP 30 mg twice within 24 hours after TUR was effective as prophylactic therapy for non-muscle-invasive cancer with tolerable toxicity problems.


QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
E S Saber ◽  
A M Ibrahim ◽  
F M Benjamine

Abstract Background In laparoscopic sleeve gastrectomy, patients may experience some post-operative complications as hemorrhage or leakage.We aim by this study to evaluate the benefit of omental fixation with full thickness stitches in decreasing post-operative hemorrhage and leakage, and the mutual effect on the patient and the surgeon. Methods A retrospective analysis of collected data including 200 laparoscopic sleeve gastrectomy (LSG) from September 2016 to September 2018, procedures were divided into two groups, group A of 100 LSG procedures without omental fixation but clipping the whole suture line with titanium clips if any bleeding point present, and group B 100procedures with omental fixation with full thickness stitches till the level of incisura above, and below with titanium clips to control bleeders if present. Results Of group A there were 9 cases of leakage needed intragastric stent and feeding jejunostomy (0.9%), 26 cases of bleeding (2.6%) 15 cases of them needed relaparoscopy and ful lthickness stitches (1.5%) and 11 cases of them managed conservatively with blood transfusion (1.1%), and 3 cases of perigastric localized collection managed by pigtail and antibiotics (0.3%), average operative time was 55 minutes (between 35-75 minutes).Of group B there were 8bleeding cases of drain with less than 300 cc were managed conservatively (0.8%), and 1 case of perigastric localized collection managed conservatively without pigtail (0.1%), No leakage was identified nor hematoma, average operative time 85 minutes (between 50 to 120 minutes). Conclusion The step of omental fixation with full thickness stitches has shown to be effective in decreasing staple line bleeding and leakage although it minimally prolongs the operative time of LSG.


2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Yangjing Lin ◽  
Jin Cao ◽  
Changgui Zhang ◽  
Liu Yang ◽  
Xiaojun Duan

Background. Both percutaneous Achilles tendon lengthening by triple hemisection and the traditional open Z-lengthening are effective methods for Achilles tendon contracture. This study aims to evaluate the efficacy and safety of this new therapeutic method, which is based on the percutaneous sliding technique with three hemi-cuts in the tendon, as compared with the traditional open Z-lengthening. Methods. Retrospective analysis of the Achilles tendon contracture cases in our hospital between January 2010 and September 2016 was conducted. Twenty-five cases received percutaneous Achilles tendon lengthening (group A), and 30 patients who underwent open Z-lengthening during the same period were in the control group (group B). Operative time and hospital stay were statistically analyzed. Incision complication, equinus recurrence rate and Achilles tendon rupture morbidity were recorded. The function was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) score. All cases in group A received Magnetic Resonance Imaging (MRI) of ankle preoperatively and in the follow-ups. Results. The mean follow-up period was 42.04 months in group A and 61.7 months in group B. The entire operative time and the mean hospitalization days were lower in group A than in group B. No incision and infection complication occurred in group A. The infection rate in group B was 3.3%. Equinus recurrence rate was 4% in group A and the equinus recurrence rate in group B was 21.4%. In group A, the mean AOFAS score increased from 64 ± 10.16 points preoperatively to 96.08 ± 3.17 at final follow-up, while the score in group B increased from 63.48 ± 6.2 points to 85.4 ± 10.3. MRI showed continuity of the Achilles tendon and homogeneous signal in group A. Conclusion. Modified surgery can significantly reduce the risk of Achilles tendon rupture, provide better balance in soft tissue strength between ankle dorsiflexion and ankle plantarflexion, helping to avoid recurrence of the deformity.


2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Valeria Tognoni ◽  
Domenico Benavoli ◽  
Emanuela Bianciardi ◽  
Federico Perrone ◽  
Simona Ippoliti ◽  
...  

Introduction. The placement of ring or band around the gastric tube might prevent the dilation after Laparoscopic Sleeve Gastrectomy (LSG). We describe the first randomized study comparing LSG and Laparoscopic Banded Sleeve Gastrectomy (LBSG).Material and Method. Fifty obese patients were enrolled in the study between January 2014 and January 2015. We analysed differences in operative time, complication rate, mortality, and BMI between the two groups over a period of 12 months.Results. Twenty-five patients received LSG (group A) and 25 LBSG (group B). The mean preoperative BMI was47.3±6.58 kg/m2and44.95±5.85 kg/m2, respectively, in the two groups. There was no statistical relevant difference in operative time. No intraoperative complications occurred. Mean BMI registered after 3, 6, and 12 months in groups A and B, respectively, were37.86±5.72 kg/m2and37.58±6.21 kg/m2(p=0.869),33.64±6.08 kg/m2and32.03±5.24 kg/m2(p=0.325), and29.72±4.40 kg/m2and27.42±4.47 kg/m2(p=0.186); no statistical relevant difference was registered between the two groups.Conclusion. LBSG is a safe and feasible procedure. The time required for the device positioning did not influence significantly the surgical time. The results of bodyweight loss did not document any statistically significant differences among the two groups, even though LBSG group showed a mean BMI slightly lower than that of the control group.


Author(s):  
Md Tanzil Ansari ◽  
Sukumar Ghosh ◽  
Shailendra Kumar Singh

Nowadays, people are more vulnerable to metabolic disorders due to their faulty dietary and behavioural habits. One such disorder is Vatarakta which causes functional impairment due to involvement of Sandhi (joints). It is manifested by Ruk, Toda, Sparsha asahatva, Shopha, Raga, Daha and Stabdhata in Sandhi. Vatarakta can be correlated with Hyperuricaemia or Gout due to similarity in their clinical features. Hyperuricaemia is defined as abnormally high level of uric acid in blood (i.e. >6mg/dl in female and >7mg/dl in male). On the other hand, Gout is an inflammatory response to monosodium urate crystals formed secondary to hyperuricaemia. Aims and objectives: 1. To evaluate the effectiveness of Trikarshika kwatha and lifestyle modification in the management of Vatarakta. 2. To compare the effects of Trikarshika kwatha with and without lifestyle modification in the management of Vatarakta. Materials and methods: Raw herbs of the research formulation were collected after proper identification and Kwatha was prepared for oral administration. For the clinical study, total 60 patients were selected on the basis of selection criteria. Selected patients were randomly divided into two groups. (i) Group A: 30 patients were treated with Trikarshika kwatha. (ii) Group B: 30 patients were treated with Trikarshika kwatha along with Lifestyle modification. Individual patient was treated for 45 days along with follow up at the interval of every 15 days. To assess the effectiveness of treatment, scoring pattern was followed for subjective and objective parameters. They were assessed before and after treatment. The collected data were analysed statistically by using Paired t-test. Results: On the basis of all statistical data, it can be said that patients of Group B showed better results in all parameters in comparison to patients of Group A. Conclusion: Both Trikarshika kwatha and Lifestyle modification are affective but Trikarshika kwatha with Lifestyle modification is more effective than Trikarshika kwatha without Lifestyle modification in the management of Vatarakta.


2018 ◽  
Vol 108 (1) ◽  
pp. 10-16 ◽  
Author(s):  
E. M. Kikkas ◽  
T. Sillakivi ◽  
J. Suumann ◽  
Ü. Kirsimägi ◽  
T. Tikk ◽  
...  

Background and Aims: The aim of this study was to evaluate the long-term (5-year follow-up) results of laparoscopic sleeve gastrectomy in terms of weight loss and obesity-related comorbidities, as well as the risk factors associated with postoperative nutritional deficiencies. Material and Methods: The first 99 consecutive patients who underwent laparoscopic sleeve gastrectomy for the treatment of morbid obesity between October 2008 and August 2011 at Tartu University Hospital were followed prospectively in cohort study. The outpatient hospital follow-up visits were conducted at 3 months, 1 year, and 5 years postoperatively. At 5 years, the follow-up rate was 90.9%; 86 laparoscopic sleeve gastrectomy patients were included in final analysis. Results: The mean excess weight loss (%EWL) was 44.3% ± 13.0%, 75.8% ± 23.1%, and 61.0% ± 24.3% at 3 months, 1 year, and 5 years, respectively. A linear association between preoperative weight and weight at 5 years was found. Remission rates at 5-year follow-up for type 2 diabetes, hypertension, dyslipidemia, and obstructive sleep apnea were 68.8%, 32.7%, 27.4%, and 61.5%, respectively (all p < 0.05). There was a statistical difference (p < 0.05) in the dynamics of triglyceride, low-density lipoprotein, and high-density lipoprotein level at 5-year follow-up but the level of total cholesterol did not show significant improvement. The risk for cumulative iron, vitamin B12 deficiency, and anemia was 20%, 48%, and 28%, respectively. Conclusion: In conclusion, laparoscopic sleeve gastrectomy ensured long-term excess weight loss 61.0% at 5 years. Laparoscopic sleeve gastrectomy has a long-term effect on significant improvement in the median values of triglycerides, low-density lipoproteins, and high-density lipoproteins, but not on total cholesterol levels. There is a risk of postoperative vitamin B12 and iron deficiency.


BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Paulina Woźniewska ◽  
Inna Diemieszczyk ◽  
Dawid Groth ◽  
Łukasz Szczerbiński ◽  
Barbara Choromańska ◽  
...  

Abstract Background The incidence of obesity has been constantly growing and bariatric procedures are considered to be the most effective treatment solution for morbidly obese patients. The results of laparoscopic sleeve gastrectomy (LSG) may differ depending on patient’s age, gender, preoperative body mass index (BMI) and physical activity. Methods The aim of this study was to evaluate age-related differences in the outcome of LSG in terms of weight loss parameters, lipid and carbohydrate profile. The retrospective analysis of 555 patients who had undergone LSG was performed to compare the metabolic outcomes of surgery in individuals < 45 and ≥ 45 years old. Evaluation of weight loss parameters along with selected laboratory data was performed to demonstrate the results of LSG in 2 years follow-up. Results Overall, 238 males and 317 females (43%/57%) with median age of 43 years and median preoperative BMI of 46.41 (42.06–51.02) kg/m2 were analyzed. Patients in both groups presented significant weight loss at 24 months after the surgery with comparable percentage of total weight loss (40.95% in < 45 years old group and 40.44% in ≥ 45 years old group). The percentage of excess weight loss (78.52% vs. 74.53%) and percentage of excess BMI loss (91.95% vs. 88.01%) were higher in patients < 45 years old. However, the differences were not statistically significant (p = 0.662, p = 0.788 respectively). Patients under 45 years old experienced faster decrease in fasting glucose level that was observed after only 3 months (109 mg/dl to 95 mg/dl in < 45 years old group vs. 103.5 mg/dl to 99.5 mg/dl in ≥ 45 years old group, p < 0.001). Both groups presented improvement of lipid parameters during the observation. However, patients < 45 years old achieved lower values of LDL at 3 and 12 months follow-up (115 mg/dl vs. 126 mg/dl, p = 0.010; 114.8 mg/dl vs. 122 mg/dl, p = 0.002). Younger group of patients also showed superior improvement of triglycerides level. Conclusions LSG results in significant weight loss in all patients regardless age. In turn, superior and faster improvement in lipid and carbohydrate profile is achieved in patients under 45 years old.


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