Hand-assisted laparoscopic nephrectomy in morbidly obese patients

2020 ◽  
Vol 99 (6) ◽  
pp. 271-276
Keyword(s):  
Body Weight ◽  
Surgical Technique ◽  
Blood Loss ◽  
Hospital Stay ◽  
Kidney Cancer ◽  
The Body ◽  
Laparoscopic Nephrectomy ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Morbid Obese

Introduction: Prevalence of obesity is 30 % in the Czech Republic and is expected to increase further in the future. This disease complicates surgical procedures but also the postoperative period. The aim of our paper is to present the surgical technique called hand-assisted laparoscopic nephrectomy (HALS), used in surgical management of kidney cancer in morbid obese patients with BMI >40 kg/m2. Methods: The basic cohort of seven patients with BMI >40 undergoing HALS nephrectomy was retrospectively evaluated. Demographic data were analyzed (age, gender, body weight, height, BMI and comorbidities). The perioperative course (surgery time, blood loss, ICU time, hospital stay and early complications), tumor characteristics (histology, TNM classification, tumor size, removed kidney size) and postoperative follow-up were evaluated. Results: The patient age was 38−67 years; the cohort included 2 females and 5 males, the body weight was 117−155 kg and the BMI was 40.3−501 kg/m2. Surgery time was 73−98 minutes, blood loss was 20−450 ml, and hospital stay was 5−7 days; incisional hernia occurred in one patient. Kidney cancer was confirmed in all cases, 48–110 mm in diameter, and the largest removed specimen size was 210×140×130 mm. One patient died just 9 months after the surgery because of metastatic disease; the tumor-free period in the other patients currently varies between 1 and 5 years. Conclusion: HALS nephrectomy seems to be a suitable and safe surgical technique in complicated patients like these morbid obese patients. HALS nephrectomy provides acceptable surgical and oncological results.

scholarly journals Impact of weight on stone-free rate during percutaneous nephrolithotomy

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Abdrabuh M. Abdrabuh
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Operative Procedure ◽  
World Health ◽  
Fluoroscopy Time ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Co Morbidity ◽  
Stone Free Rate ◽  
Morbid Obese ◽  
Free Rate

Abstract Background To assess Impact of weight on stone-free rate during percutaneous nephrolithotomy. Methods Hundred and twenty-three PNL procedures were done between January 2016 and July 2017. The patients were divided into four groups according to the World Health Organization (WHO) classification of body mass index (BMI): < 25 ((group 1, average)), 25–29.9 (group 2, overweight), 30–39.9 (group 3, obese), and ≥ 40 kg/m2 (group 4, morbidly obese). All groups were compared as regarding preoperative variables, intra-operative procedure and postoperative results. Results The non-obese groups were younger in age than obese and morbid obese groups (P = 0.005). The difference in BMI was statistically significant between non-obese and obese groups (P = 0.0001). Most of females gender were obese and morbid obese (P = 0.0001) and most of the obese patients had left-sided renal stone (P = 0.001). Most of overweight and obese groups had radiopaque stones (P = 0.02). There were no statistically significant differences between all groups as regarding co-morbidity, stone size, stone locations, and hydronephrosis grade. Operative time (P = 0.034), length of hospital stay (P value = 0.014) and fluoroscopy time (P = 0.0001) were statistically significant differences between all groups. Number of accesses, access site, postoperative hemoglobin drop, post- operative complications, fate of residual stones and stone-free rate were not statistically significant differences between all groups. BMI was correlated with mean fluoroscopy time and mean hospitalization duration in our study as the time of hospitalization and time of x-ray exposure increase with obesity. Conclusion PNL is a safe and effective procedure for obese patients. BMI do not predict clearance post PNL.

Assessing Safety and Efficacy of Lean Body Weight-Based intravenous Heparin Dosing in Obese and Morbidly Obese Patients

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 1010A ◽  
Author(s):  
Rachel Park ◽  
Scott Chelemer ◽  
Jason Varghese ◽  
Cheryl Leddy ◽  
Lewis Rose
Keyword(s):  
Body Weight ◽  
Lean Body Weight ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Safety And Efficacy ◽  
Intravenous Heparin

Ideal versus corrected body weight for dosage of sugammadex in morbidly obese patients

Anaesthesia ◽  
2011 ◽  
Vol 66 (8) ◽  
pp. 721-725 ◽  
Author(s):  
P. Van Lancker ◽  
B. Dillemans ◽  
T. Bogaert ◽  
J. P. Mulier ◽  
M. De Kock ◽  
...  
Keyword(s):  
Body Weight ◽  
Morbidly Obese ◽  
Obese Patients

scholarly journals Reduced Postoperative Pain and Complications after a Modified Multidisciplinary Approach for Bariatric Surgery

2013 ◽  
Vol 5 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Rachel A. Karlnoski ◽  
Collin Sprenker B.S ◽  
Suvikram Puri ◽  
Ren Chen ◽  
Devanand Mangar ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Pain Management ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Medical Center ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Pain Scores ◽  
Operative Care ◽  
Analgesic Regimen

Background: There are considerable implications for pain management in morbidly obese patients undergoing weight loss operations. The purpose of this study was to determine if a modified postoperative analgesic regimen and a dedicated postoperative bariatric team reduced pain scores, length of stay and postoperative complications. Materials and Methods: We performed a retrospective analysis of morbidly obese patients admitted to our medical center for laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB). Our previous postoperative pain regimen was ketorolac (30 mg IV plus 15 mg q6h) and patient controlled analgesia (PCA) morphine and was converted to ketorolac (30 mg IV and 30 mg i.m, plus 15 mg q6h), and IV PCA hydromorphone. Visual analog scale (VAS) pain scores from the post-operative care unit were collected retrospectively. The bariatric team was led by a nurse practitioner consisted of a psychologist, exercise physiologist, and nutritionist. Results: Eighty-five patients underwent bariatric operations in the year prior to implementation of the revised postoperative pain management regimen and 372 patients underwent bariatric surgery in the 2 years following implementation. Patient age, gender and BMI were evenly distributed for both groups. Mean VAS scores on postoperative days 1 through 5 were significantly lower after implanting our modified pain regimen (p<0.0001). Pain scores were significantly higher for patients that underwent LRYGB compared to LAGB (p<0.0001). Overall, length of hospital stay was unaffected by the new pain regimen, however a significant reduction was found in patients that underwent LAGB (0.8 days less; p=0.0001). Conclusion: Use of our modified pain regimen resulted in a more effective analgesic protocol and a reduction of hospital stay, without added complications or side effects.

scholarly journals Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

2021 ◽  
Vol 8 (1) ◽  
pp. 37-42
Author(s):  
Hasan Ghandhari ◽  
◽  
Ebrahim Ameri ◽  
Mohsen Motalebi ◽  
Mohamad-Mahdi Azizi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Obese Group ◽  
Obese Patients ◽  
Number Of Patients ◽  
Significant Difference ◽  
Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

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

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 &gt; 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 .

Features of the course of acute pancreatitis in patients with obesity

2019 ◽  
Vol 91 (5) ◽  
pp. 1-5 ◽  
Author(s):  
Andriy Kebkalo ◽  
Olha Tkachuk ◽  
Adrian Reyti
Keyword(s):  
Acute Pancreatitis ◽  
Body Weight ◽  
Mortality Rate ◽  
The Body ◽  
Obese Patients ◽  
Correlation Relationship ◽  
Systemic Complications ◽  
Key Words Acute Pancreatitis ◽  
Normal Body ◽  
Normal Body Weight

Abstract The purpose of the study is to investigate the course of acute pancreatitis in obese patients, the development of local and systemic complications and mortality rates. Materials and methods We have taken and analyzed 482 histories of acute pancreatitis, who has been treatmented at Kyiv Regional Clinical Hospital from January 1, 2011 to February 2, 2019. The data were statistically processed in the Exel 2010 program using a descriptive method using relative , absolute numbers, mean square deviations and their errors. A correlation relationship between variables was studied using the Pearson criterion (R2). Testing the significance of the difference between the two independent groups was carried out with the help of the t-criterion of the Student. Results In our study we had 482 patients, 260 patients (54%) had obesity (the study group), for comparison, a control group of patients with normal body weight was chosen, the total number of which was 222 (46%) patients. Obesity patients had a higher average age (55.4 ± 9.4 years, p = 0.01), also they had statistically greater percentage of severe cases of acute pancreatitis (85 (32.7%) vs 16 (7.2%); p = 0.01 *). We note the increase in the percentage of the course of severe pancreatitis in patients with weight gain from 10.20% to 53.93% (p = 0.03) *. Obesity patients had the longer bed-days in the hospital than in patients with normal body weight. In addition, they observed an increase of twice the bed in the reanimation and intensive care unit (5.8 ± 0.8 vs 2.7 ± 0.5 days, p = 0.01 *). When investigating the mortality rate, it should be noted that the main cause of death was the progression of organ failure of 30 (6.3%), pulmonary embolism (TB) - 15 (3.1%) and DIC 18 (3.7%) . Conclusions. The presence of obesity in patients involves a high risk of severe acute pancreatitis, this risk increases with an increase in the body mass index. In addition, in obese patients we have a higher bed-day in-patient and in-patient-care settings, which increases the total cost of treatment and requires a cost-effective algorithm in the future. A high mortality rate in obese patients requires improved treatment algorithm. Key words: acute pancreatitis, obesity.

Response to Starvation before and after a Jejuno-Ileal Bypass Operation for Morbid Obesity

1979 ◽  
Vol 24 (3) ◽  
pp. 206-210 ◽  
Author(s):  
G. A. A. Al Shamma ◽  
G. S. Fell ◽  
S. N. Joffe
Keyword(s):  
Morbid Obesity ◽  
Metabolic Response ◽  
Ketone Bodies ◽  
The Body ◽  
Metabolic Adaptation ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Bypass Operation ◽  
Before And After ◽  
Ileal Bypass

A greater metabolic response developed during a seven day starvation in two morbidly obese patients three months after a 90 per cent jejuno-ileal bypass operation when compared with a similar fast before operation. There was a greater degree of ketosis, a decreased urinary urea excretion and an earlier utilization of ketone bodies. These changes suggest a metabolic adaptation of the body to the semistarvation state caused by the operation with a more rapid utilization of adipose tissue as a fuel and a sparing of lean body mass.

scholarly journals Robot-Assisted Laparoscopic Radical Prostatectomy in the Morbidly Obese Patient

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Jennifer Yates ◽  
Ravi Munver ◽  
Ihor Sawczuk
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
The United States ◽  
Morbidly Obese ◽  
Health Issues ◽  
Morbidly Obese Patient ◽  
Estimated Blood Loss ◽  
Clavien Grade ◽  
Grade Ii

Introduction. Obesity and prostate cancer are among the more common health issues affecting men in the United States.Methods. We retrospectively reviewed morbidly obese (BMI ≥ 40 kg/m2) patients undergoing RALP between 2004–2009 at our institution. Parameters including operative time, estimated blood loss, hospital stay, pathology, and complication rate were examined.Results. A total of 15 patients were included, with a mean BMI of 43 kg/m2. Mean preoperative PSA was 5.78 ng/dL, and Gleason score was 6.6. Mean operative time was 163 minutes, and mean estimated blood loss was 210 mL. The mean hospital stay was 1.3 days. Positive margins were noted in 2 (13%) patients, each with pT3 disease. There were no blood transfusions, open conversions, or Clavien Grade II or higher complications.Conclusions. In our experience, RALP is feasible in morbidly obese patients. We noted several challenges in this patient population which were overcome with modification of technique and experience.

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