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Biomedical subjects

George M Eid

Publications and source records attributed to George M Eid.

10 recordsLinked to original sources
PubMed2005

Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome.

OBJECTIVE: To evaluate the effects of surgical weight loss on fatty liver disease in severely obese patients. SUMMARY BACKGROUND DATA: Nonalcoholic fatty liver disease (NAFLD), a spectrum that extends to liver fibrosis and cirrhosis, is rising at an alarming rate. This increase is occurring in conjunction with the rise of severe obesity and is probably mediated in part by metabolic syndrome (MS). Surgical weight loss operations, probably by reversing MS, have been shown to result in improvement in liver histology. METHODS: Patients who underwent laparoscopic surgical weight loss operations from March 1999 through August 2004, and who agreed to have an intraoperative liver biopsy followed by at least one postoperative liver biopsy, were included. RESULTS: There were 70 patients who were eligible. All patients underwent laparoscopic operations, the majority being laparoscopic Roux-en-Y gastric bypass. The mean excess body weight loss at time of second biopsy was 59% +/- 22% and the time interval between biopsies was 15 +/- 9 months. There was a reduction in prevalence of metabolic syndrome, from 70% to 14% (P < 0.001), and a marked improvement in liver steatosis (from 88% to 8%), inflammation (from 23% to 2%), and fibrosis (from 31% to 13%; all P < 0.001). Inflammation and fibrosis resolved in 37% and 20% of patients, respectively, corresponding to improvement of 82% (P < 0.001) in grade and 39% (P < 0.001) in stage of liver disease. CONCLUSION: Surgical weight loss results in significant improvement of liver morphology in severely obese patients. These beneficial changes may be associated with a significant reduction in the prevalence of the metabolic syndrome.

Biopsy↗
PubMed2004

Results of laparoscopic gastric bypass in patients with cirrhosis.

BACKGROUND: The safety and efficacy of bariatric surgery in patients with cirrhosis has not been well studied. METHODS: A retrospective review was conducted of patients with cirrhosis who underwent weight-loss surgery at a single institution. RESULTS: Out of a total of 2119 patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGBP), 30 patients (1.4%) with cirrhosis were identified. When compared with the entire cohort, patients with cirrhosis were significantly more prone to be heavier (BMI 53 vs 48), older in years (age 50 vs 45), more likely to be male (RR=1.3), and have a higher incidence of diabetes (70% vs 21%) and hypertension (67% vs 21%), P<0.05. The diagnosis of cirrhosis was made intra-operatively in 90% of patients. There were no perioperative deaths, conversions to laparotomy, or liver-related complications. Early complications occurred in 9 patients and included anastomotic leak (1), acute tubular necrosis (4), prolonged intubation (2), ileus (1), and blood transfusion (2). Mean length of hospital stay was 4 days (2-18). There was one late unrelated death and one patient with prolonged nausea and protein malnutrition. The average follow-up time was 16 months (1-48). For patients >12 months postoperatively (n=15), the average percent excess weight loss was 63+/-15%. CONCLUSION: Laparoscopic RYGBP in the cirrhotic patient has an acceptable complication rate and achieves satisfactory early weight loss. Patients tend to be heavier, older, male and more likely to have diabetes and hypertension. Long-term studies are necessary to examine how weight loss impacts established cirrhosis.

Adult↗
PubMed2003

Medium-term follow-up confirms the safety and durability of laparoscopic ventral hernia repair with PTFE.

BACKGROUND: Ventral abdominal wall hernias are common lesions and may be associated with life-threatening complications. The application of laparoscopic principles to the treatment of ventral hernias has reduced recurrence rates from a range of 25% to 52% to a range of 3.4% to 9%. In this study, we review our experience and assess the clinical outcome of patients who have undergone laparoscopic repair of ventral hernias. METHODS: We reviewed the outcome of 79 patients with more than 1 year of follow-up who underwent laparoscopic ventral hernia repair between March 1996 and December 2001. Patient demographics, hernia characteristics, operative parameters, and clinical outcomes were evaluated. RESULTS: Of the 79 patients, 37 were males. Mean age was 55.8 years (range 28-81). Sixty-eight patients had incisional hernias, including 17 with recurrent hernias. Eleven patients had primary ventral hernias. The mean defect size was 103 cm(2) (range 4-510); incarceration was present in 22 patients (27.8%), and multiple (Swiss-cheese) defects in 20 (25.3%). Laparoscopic expanded polytetrafluoroethylene mesh repair by the modified Rives-Stoppa technique was completed in 78 (98.7%). One conversion occurred because of bowel injury. The mean operating time was 110 minutes (range 45-210) and mean hospital stay was 1.7 days (range 0-20), with 46 patients (58.2%) being discharged within 24 hours of surgery. Complications included seroma formation (3), chronic pain (3), prolonged ileus (1), hematoma formation (1), and missed bowel injury (1) for a complication rate of (11.4%). There were no deaths. After a follow-up of up to 6 years (a mean of 34 months), there were 4 recurrences (5%). CONCLUSION: The laparoscopic repair of ventral hernias is safe, effective, and durable with minimal morbidity. It is particularly successful in patients with recurrent lesions. The laparoscopic approach to ventral hernia repair should be considered the standard of care.

Adult↗
PubMed2003

Laparoscopic Roux-en-Y gastric bypass in morbidly obese adolescents.

BACKGROUND/PURPOSE: Obesity has contributed significantly to morbidity and premature deaths in the adolescent population. Because many patients do not respond to dietary modification, exercise regimens, or pharmacologic treatment, weight reduction surgery has become a viable alternative, although the morbidity of conventional gastric bypass has tempered enthusiasm for this approach. Experience with the laparoscopic approach has not been reported previously. The authors examined the outcome of adolescents undergoing laparoscopic Roux-En-Y gastric bypass (lap RYGB). METHODS: Medical records of patients less than 20 years of age (n = 4; 3 girls, 1 boy) who had undergone lap RYGB for morbid obesity were reviewed. All patients met National Institute of Health criteria for bariatric surgery. Outcome variables examined included weight; body mass index (BMI); hospital length of stay (LOS); comorbid conditions; and tolerance of a regular diet. Mean time to follow-up was 17 months. RESULTS: All procedures were completed laparoscopically. There were no complications. The average LOS was 2 days. Patients with greater than 20-month follow-up lost an average of 87% of their excess body weight and had nearly complete resolution of comorbidities (including hypertriglyceridemia, hypercholesterolemia, asthma, and gastroesophageal reflux disease). CONCLUSION: Laparoscopic gastric bypass is a safe alternative in morbidly obese adolescents who have not responded to medical therapy.

Adolescent↗
PubMed2003

Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus.

OBJECTIVE: To evaluate pre- and postoperative clinical parameters associated with improvement of diabetes up to 4 years after laparoscopic Roux-en-Y gastric bypass (LRYGBP) in patients with type 2 diabetes mellitus (T2DM). SUMMARY BACKGROUND DATA: The surgical treatment of morbid obesity leads to dramatic improvement in the comorbidity status of most patients with T2DM. However, little is known concerning what preoperative clinical factors are associated with postoperative long-term improvement in diabetes in the morbidly obese patient with diabetes. METHODS We evaluated pre- and postoperative data, including demographics, duration of diabetes, metabolic parameters, and clinical outcomes, in all patients with impaired fasting glucose (IFG) and type T2DM undergoing LRYGBP from July 1997 to May 2002. RESULTS: During this 5-year period, 1160 patients underwent LRYGBP and 240 (21%) had IFG or T2DM. Follow up was possible in 191 of 240 patients (80%). There were 144 females (75%) with a mean preoperative age of 48 years (range, 26-67 years). After surgery, weight and body mass index decreased from 308 lbs and 50.1 kg/m2 to 211 lbs and 34 kg/m2 for a mean weight loss of 97 lbs and mean excess weight loss of 60%. Fasting plasma glucose and glycosylated hemoglobin concentrations returned to normal levels (83%) or markedly improved (17%) in all patients. A significant reduction in use of oral antidiabetic agents (80%) and insulin (79%) followed surgical treatment. Patients with the shortest duration (<5 years), the mildest form of T2DM (diet controlled), and the greatest weight loss after surgery were most likely to achieve complete resolution of T2DM. CONCLUSION: LRYGBP resulted in significant weight loss (60% percent of excess body weight loss) and resolution (83%) of T2DM. Patients with the shortest duration and mildest form of T2DM had a higher rate of T2DM resolution after surgery, suggesting that early surgical intervention is warranted to increase the likelihood of rendering patients euglycemic.

Adult↗
PubMedDate not supplied

Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass.

PURPOSE: Many women with polycystic ovarian syndrome (PCOS) are overweight. This study investigated the impact of weight loss surgery on the clinical manifestations of this disorder in morbidly obese women with PCOS-a major risk factor for the development of heart disease, stroke, and type II diabetes. METHODS: We reviewed the outcomes of women diagnosed with PCOS who had undergone weight loss surgery at the University of Pittsburgh between July 1997 and November 2001. We evaluated the changes in menstrual cycles, hirsutism, infertility, and type II diabetes. RESULTS: A total of 24 women with PCOS were included in the study. Their mean age was 34 +/- 9.7 years. The mean preoperative body weight was 306 +/- 44 lb, with a body mass index of 50 +/- 7.5. All patients were oligomenorrheic. Of the 24 patients, 23 were hirsute. All women underwent elective laparoscopic gastric bypass surgery. The mean follow-up period was 27.5 +/- 16 months. The mean excess weight loss at 1 year of follow-up was 56.7% +/- 21.2%. All women resumed normal menstrual cycles after a mean of 3.4 +/- 2.1 months postoperatively. Of the 23 women with hirsutism, 12 (52%) had complete resolution at a mean follow-up of 8 +/- 2.3 months, 6 (25%) had moderate resolution at a mean of 21 +/- 18 months, and 3 had minimal resolution at 34 +/- 14 months. Two women reported no change in their hirsutism at 32 +/- 7 months. Five women were able to conceive after surgery without the use of clomiphene. CONCLUSION: Gastric bypass surgery and its consequent weight loss results in significant improvement of multiple clinical problems related to PCOS.

Adult↗
PubMedDate not supplied

Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass.

OBJECTIVES: A precipitating factor for marginal ulcer formation after Roux-en-Y gastric bypass may be the prolonged irritation by foreign material, such as nonabsorbable suture at the gastrojejunostomy. This study examines the incidence of marginal ulcers before and after a change was made from using nonabsorbable suture to using absorbable suture for the inner layer of the anastomosis. METHODS: A total of 3285 laparoscopic Roux-en-Y gastric bypass operations were performed during a 5-year period. The gastrojejunostomy technique was modified in August 2002. Those patients who developed a marginal ulcer postoperatively were identified, and their charts were retrospectively analyzed for the operative technique, patient age, history of previous gastric surgery, presence of preoperative diabetes, coronary artery disease, or peptic ulcer disease, and use of nonsteroidal anti-inflammatory medications or tobacco. RESULTS: The incidence of marginal ulceration after Roux-en-Y gastric bypass decreased significantly from 2.6% (28/1095) with the use of nonabsorbable suture to 1.3% (29/2190) after the change to absorbable suture for the inner layer of the gastrojejunal anastomosis (P < .001). The incidence of visible suture adjacent to the ulcer on endoscopy was also significantly reduced (64.3% vs 3.4%; P < .001). When the results were corrected for length of follow-up, the difference in the incidence of ulcers occurring within 1 year of surgery remained significant between the two groups (P = .002). There were no other significant differences in the factors analyzed. CONCLUSIONS: The use of nonabsorbable sutures for the inner layer of the gastrojejunal anastomosis is associated with an increased incidence of marginal ulcers, and the adoption of absorbable suture material has reduced this incidence.

Adult↗
PubMedDate not supplied

Application of a trocar wound closure system designed for laparoscopic procedures in morbidly obese patients.

Herniation into the trocar-site is a relatively common complication of laparoscopic surgery, and represents a serious cause of morbidity because of the potential to develop into a Richter's hernia. The risk of trocar-site herniation is greater in obese and bariatric patients, because of the larger preperitoneal space and elevated intra-abdominal pressure; thus, fascial closure alone is not adequate. Full-thickness trocar-wound closure can prevent this complication. However, hand suturing and some port-closure devices can be difficult to use in this patient group. We report on the use of a specialized trocar wound closure system designed for use on obese and bariatric patients. In this report, we describe use of the system in the case of a 34-year-old Caucasian female who underwent a laparoscopic Roux-en-Y gastric bypass procedure.

Adult↗
PubMedDate not supplied

Laparoscopic repair of umbilical hernias in conjunction with other laparoscopic procedures.

BACKGROUND: This study evaluates the feasibility of laparoscopic transfascial suture repair of umbilical hernias when combined with another laparoscopic procedure that potentially contaminates the peritoneal cavity. METHOD: From August 1997 to November 2001, 32 patients underwent laparoscopic umbilical suture repair in association with another laparoscopic procedure. The repair was performed with the Carter-Thomason suture passer. RESULTS: Of the 32, 26 patients with more than 1-year follow-up were included in the study. The mean diameter of the umbilical hernia defect was 1.67 cm (range, 0.5 to 3). At a mean follow-up of 34 months (range, 12 to 60), there were only 2 recurrences (7.7%) both of which happened in patients with hernia defects larger than 2 cm in diameter. Apart from 2 wound infections, no other complications occurred. CONCLUSION: Laparoscopic suture repair of umbilical hernias with the suture passer method is effective and durable even when combined with other laparoscopic procedures that potentially contaminate the peritoneal cavity with bile or enteric contents.

Adult↗