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J L Zapas

Publications and source records attributed to J L Zapas.

4 recordsLinked to original sources
PubMed1998

Prophylactic jejunostomy: a reappraisal.

BACKGROUND: The effectiveness of enteral feeding in maintaining postoperative nutrition has led some investigators to recommend prophylactic jejunostomy at the time of any high-risk abdominal operation. A failed procedure in this setting weighs heavily on the side of risk without identifiable benefit. METHODS: A benefit/risk analysis comparing complication rate, avoidance of parenteral nutrition, and discontinuation of jejunostomy feeding was performed in 92 patients. These patients were judged retrospectively to be undergoing either a prophylactic jejunostomy placed at the time of operation for another serious condition (group A) or therapeutic jejunostomy alone (group B) during a 3-year period (1993 to 1996). Classification as prophylactic or therapeutic was determined by the surgeon's preoperative intent. RESULTS: Avoidance of parenteral nutritional support, a goal of prophylactic jejunostomy, was not achieved in 39% of the patients. Patients in group A had a 5-fold increase in the risk of premature discontinuation of enteral feeds when compared with group B (P < .03). The complication rate was higher in group A (41%) than in group B (26%). Four life-threatening complications occurred in group A; all required reversal of the feeding jejunostomy. CONCLUSIONS: This study suggests that the benefit/risk ratio of prophylactic jejunostomy is low. This adds weight to the notion that this procedure be abandoned in favor of other forms of nutritional support.

Adolescent↗
PubMed1998

Divided gastric bypass: a fifteen-year experience.

In suitable candidates, a reduction in gastric capacity to achieve significant weight loss is life-saving. The number and variety of procedures proposed in the last 15 years suggest that the ideal operation is still in evolution. We present a 15-year experience with a single operation designed to avoid the hazards of staple line dehiscence, achieve maximum weight loss, and maintain physiologic homeostasis. From 1979 through 1994, 212 patients, whose age, weight, and number of medical complications were consistent with the criteria for morbid obesity, underwent divided gastric bypass. All patients lost at least 70 lbs, and 95 per cent of the patients lost greater than 100 lbs in 2 years, with an average loss higher than in most comparable series. There were four post operative deaths and three late deaths. Thirteen anastomotic leaks (6%) were successfully managed. Eight patients received nutritional support and antibiotics, and five patients had operative drainage. Eighteen per cent had one or more minor complications. Divided gastric bypass avoids the problem of staple line dehiscence while providing a safe physiologic approach for maximum weight loss in the morbidly obese patient.

Adult↗