"Identification and management of an errant antiperistaltic roux limb after total gastrectomy".
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Anastomosis, Roux-en-Y↗
Biomedical subjects
John Alverdy
Publications and source records attributed to John Alverdy.
Use of double-balloon enteroscopy to perform PEG in the excluded stomach after Roux-en-Y gastric bypass.
BACKGROUND: Because of postoperative complications, patients who have undergone Roux-en-Y gastric bypass (RYGB) for weight loss may require radiographic investigation of the pancreaticobiliary limb or enteral feeding. Gastrostomy-tube placement into the excluded stomach for these indications is typically performed surgically or via fluoroscopic or US guidance; PEG has not been reported as being performed for this purpose. Successful examination of the excluded stomach after RYGB has been reported when using double-balloon enteroscopy (DBE). OBJECTIVE: To perform PEG in the excluded stomach by using DBE. DESIGN: Retrospective review. SETTING: Single, North American tertiary-care center. PATIENTS: Individuals with postoperative complications after RYGB that requires radiographic examination of the excluded stomach and the pancreaticobiliary limb, or enteral feeding. INTERVENTIONS: Performance of PEG within the excluded stomach by using DBE. MAIN OUTCOME MEASUREMENTS: Ability to perform PEG-procedure-related complications and resultant management changes. RESULTS: PEG was successfully performed by using DBE in 3 of 4 patients with postoperative complications after RYGB. In 2 of the cases, the results of radiographic studies performed with contrast administration through the gastrostomy tube led to significant operative management changes. In the third case, preoperative enteral nutrition was provided by using a gastrostomy tube. PEG placement was not possible in the fourth case because of the lack of abdominal transillumination. Major complications were not observed. LIMITATIONS: Small sample size, single-center experience. CONCLUSIONS: PEG placement in the excluded stomach after RYGB by using DBE was safe, technically feasible, and led to management changes in patients in whom it was performed. This procedure should be added to the growing list of indications for DBE.
Abdominal Pain↗
The impact of stress and nutrition on bacterial-host interactions at the intestinal epithelial surface.
PURPOSE OF REVIEW: Most literature that examines gut barrier function focuses on alterations in bacterial flora, changes in mucosal epithelium, or the integrity of the mucosal defenses. This review examines new concepts on the interaction between bacteria and the host, the complex relationships that serve to benefit both in times of health, and the alterations and responses that occur during illness. RECENT FINDINGS: Recent work has demonstrated a more complex relationship between bacteria and barrier integrity and between bacteria themselves, which creates a symbiotic relationship beneficial to both host and flora. Host responses alter this balance, inducing changes in bacteria that may be deleterious to both. SUMMARY: With a better understanding of the bacteria-host interactions in health and the alterations induced by critical illness, new therapies that improve the environment of both may lead to better recovery rates in intensive care unit patients.
Bacterial Translocation↗
Luminal bacterial flora determines physiological expression of intestinal epithelial cytoprotective heat shock proteins 25 and 72.
Heat shock proteins (HSP) 25 and 72 are expressed normally by surface colonocytes but not by small intestinal enterocytes. We hypothesized that luminal commensal microflora maintain the observed colonocyte HSP expression. The ability of the small intestine to respond to bacteria and their products and modulate HSPs has not been determined. The effects of luminal bacterial flora in surgically created midjejunal self-filling (SFL) vs. self-emptying (SEL) small-bowel blind loops on epithelial HSP expression were studied. HSP25 and HSP72 expression were assessed by immunoblot and immunohistochemistry. SFL were chronically colonized, whereas SEL contained levels of bacteria normal for the proximal small intestine. SFL creation significantly increased HSP25 and HSP72 expression relative to corresponding sections from SEL. Metronidazole treatment, which primarily affects anaerobic bacteria as well as a diet lacking fermentable fiber, significantly decreased SFL HSP expression. Small bowel incubation with butyrate ex vivo induced a sustained and significant upregulation of HSP25 and altered HSP72 expression, confirming the role of short-chain fatty acids. To determine whether HSPs induction altered responses to an injury, effects of the oxidant, monochloramine, on epithelial resistance and short-circuit current (I(sc)) responses to carbachol and glucose were compared. Increased SFL HSP expression was associated with protection against oxidant-induced decreases in transmural resistance and I(sc) responses to glucose, but not secretory responses to carbachol. In conclusion, luminal microflora and their metabolic byproducts direct expression of HSPs in gut epithelial cells, an effect that contributes to preservation of epithelial cell viability under conditions of stress.
Animals↗
Psychosocial outcome of gastric bypass surgery for patients with and without binge eating.
BACKGROUND: There is limited data on the prevalence of eating disorder pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGBP) and the degree to which this may affect surgical outcome. The present study examined surgical outcome between 2 groups of patients undergoing RYGBP: those with pre-surgical binge eating (BE) and those without pre-surgical binge eating (NBE). METHODS: This study tested the hypothesis that the BE group would demonstrate greater pathology on measures of eating pathology, psychological wellbeing, and quality of life than the NBE group both pre- and post-surgery. RESULTS: Compared with the NBE group, the BE group had significantly higher levels of disinhibited eating, and hunger, and significantly lower levels of social functioning at pre-surgery and 6 months post-surgery. The BE group had a significantly lower percentage of excess weight lost than the NBE group at 6 months post-surgery. CONCLUSIONS: These findings indicate a less successful outcome for the BE patients compared with the NBE patients. While there were more distinct differences between the BE and NBE groups before surgery, they were largely impossible to differentiate on psychosocial measures at post-surgery.
Adult↗
Outcome following gastric bypass surgery: impact of past sexual abuse.
BACKGROUND: This study examined gastric bypass (GBP) outcome in 2 groups of morbidly obese females: those with a history of sexual abuse (SA) and those without a history of sexual abuse (NSA). METHODS: Subjects were assessed preoperatively and at one of two time points following surgery: either 5 to 9 months or 10 to 14 months. Outcome measures included BMI, level of depression as measured through the Beck Depression Inventory (BDI), and level of self-esteem as measured through the Rosenberg Self-Esteem Scale (RSE).T-tests were conducted for pre and post scores between the 2 groups on each of the variables. RESULTS: Of the 12 tests conducted, the only statistically significant difference was on BDI scores for the 5 to 9 month post-surgery groups, with the SA groups showing a significantly higher level of depression than the NSA group. CONCLUSIONS: The results suggest that females with a history of sexual abuse are as successful with weight loss following GBP as those without a history of abuse. While females with a history of sexual abuse show significantly more depression 5 to 9 months after surgery, they are indistinguishable from those without a history of abuse 1 year following GBP.Thus, sexual abuse does not appear to be a negative prognostic indicator for GBP.
Adult↗
Binge eating and eating-related cognitions and behavior in ethnically diverse obese women.
OBJECTIVE: To examine binge eating and eating-related cognitions and behavior in a sample of ethnically diverse women who are severely obese and seeking bariatric surgery. RESEARCH METHODS AND PROCEDURES: Female bariatric surgery candidates (62 African Americans, 18 Latinas, 130 whites) completed questionnaires on binge eating and eating-related cognitions and behavior and completed a structured clinical interview to confirm binge-eating disorder diagnosis. RESULTS: Ethnic minorities and whites did not differ in rates of binge-eating disorder (26.3%), binges per week (M = 0.95), or dietary restraint. Ethnic minorities reported less disinhibition, and there was a trend to report less hunger awareness than whites. After controlling for BMI and education, ethnicity accounted for significant variance in disinhibition (4%; p < 0.01). Ethnic minorities were younger, became overweight at a later age, and were overweight for fewer years than whites. DISCUSSION: Results suggest that ethnicity exerts an important influence on disinhibition and that ethnic differences are not caused by BMI or education. Findings point to the need to continue to investigate the role of ethnicity, binge eating, and disinhibition in severely obese women, so that culturally appropriate services can be provided.
Adult↗
Pseudomonas aeruginosa expresses a lethal virulence determinant, the PA-I lectin/adhesin, in the intestinal tract of a stressed host: the role of epithelia cell contact and molecules of the Quorum Sensing Signaling System.
OBJECTIVE: We have previously demonstrated that P. aeruginosa can have profound effects on the intestinal epithelial barrier via one of its virulence factors, the PA-I lectin/adhesin. The aims of the present study were to further characterize the interaction of P. aeruginosa and the intestinal epithelium using both in vitro and in vivo approaches. METHODS: In vitro assays examining the effect of bacterial growth phase, epithelial cell contact, and butanoyl homoserine lactone (C4-HSL), a quorum sensing signaling molecule know to affect various extracellular virulence factors in P. aeruginosa, on PA-I expression in P. aeruginosa were performed. In vivo studies were carried out by modeling catabolic stress in mice using a 30% surgical hepatectomy and direct introduction of P. aeruginosa and various virulence components into the cecum. The effect of this model on PA-I expression in P. aeruginosa was determined. RESULTS: Results demonstrated that PA-I expression in P. aeruginosa is affected by its phase of growth, its contact to the intestinal epithelium, and its exposure to the quorum sensing molecule, C4-HSL. Furthermore, data from the present study suggest that the PA-I lectin/adhesin of P. aeruginosa may be increased in vivo by local factors within the cecum of mice in response to surgical stress. CONCLUSIONS: These data indicate that multiple factors present in the intestinal microenvironment of a stressed host may induce certain opportunistic pathogens to express key virulence factors leading to a state of lethal gut-derived sepsis.
Adhesins, Bacterial↗
Quality of life after gastric bypass surgery: a cross-sectional study.
OBJECTIVE: Numerous reports document significant weight loss after gastric bypass; however, there is little objective data on postsurgical changes in health-related quality of life (HRQL). RESEARCH METHODS AND PROCEDURES: This study examined HRQL in four groups of patients: presurgery (T1), several weeks postsurgery (T2), 6 months postsurgery (T3), and 1 year postsurgery (T4). Subjects were given three HRQL measures: the short form 36 (SF-36), the Impact of Weight on Quality of Life-Lite Questionnaire (IWQOL-Lite), and the Bariatric Analysis and Reporting Outcome System (BAROS). Subjects also completed the Beck Depression Inventory (BDI) and the Rosenberg Self-Esteem Scale (RSE). RESULTS: There were no significant differences among the groups on demographics or presurgical body mass index. Results showed significant differences between T1 and T2 on several SF-36 and IWQOL-Lite subscales, as well as the RSE and BDI. Significant differences were found on all measures between T2 and T3. Significant differences were found on all subscales of the IWQOL-Lite, but no subscales of the SF-36, the RSE, or the BDI between T3 and T4. DISCUSSION: This study is the first to objectively document these differences in several objective measures of HRQL, depression, and self-esteem after gastric bypass in a large sample. It is notable that many differences are apparent within several weeks after surgery. Furthermore, results indicate that the IWQOL-Lite may be more sensitive than the SF-36 to the changes of quality of life that gastric bypass patients report.
Adult↗
Region-specific adaptation of apical Na/H exchangers after extensive proximal small bowel resection.
After massive small bowel resection (MSBR), the remnant small intestine adapts to restore Na absorptive function. The possibility that this occurs through increases in cellular Na absorptive capacity was examined by assessing the regional effects of 50% proximal MSBR on the function and expression of the apical membrane Na/H exchangers (NHEs) NHE2 and NHE3. Morphometric analysis confirmed adaptive changes consistent with villus hypertrophy, particularly distal to the anastomosis. Villus epithelium prepared by light mucosal scrapings from 2-wk-postresected and -posttransected control rats exhibited comparable brush-border hydrolase activities, total cell protein per DNA, and villin expression but increased basolateral Na-K-ATPase activity. Parallel increases of two- to threefold in protein and mRNA abundance of NHE2 and NHE3 were observed only in ileal regions distal to the anastomosis of resected rats. Basolateral NHE1 expression was unchanged. After 80% resection, increases in NHE2 and NHE3 became evident in proximal colon. We conclude that increased enterocyte expression and function of apical membrane NHEs in regions distal to the anastomosis play a role in the adaptive process after MSBR. The increased luminal Na load to distal bowel regions after proximal resection may stimulate increases in apical membrane NHE gene transcription and protein expression.
Adaptation, Physiological↗
The effects of Roux-en-Y gastric bypass surgery on body image.
BACKGROUND: Numerous studies examine the physical effects of Roux-en-Y gastric bypass (RYGBP) surgery on morbid obesity. However, the effects of this surgery on psychosocial issues such as body image have not been extensively studied. METHODS: This pilot study used a cross-sectional design to examine the effects of RYGBP surgery on patients' perceived body image. Four groups (n = 20) were assessed for perceived change in body image at 4 time intervals. These included pre-surgery, 1 to 3 weeks post-surgery, 6-months post-surgery, and 1-year post-surgery, with two measures of body image. One-way ANOVA was applied, with body image measures as the dependent variables, and time since surgery (group) as the independent variable. Planned post-hoc t-tests were applied to assess the differences between specific groups (pre vs. 1 week, pre vs. 6 months post, 6 months post vs. 1 year post). RESULTS: Results of the one-way ANOVAs revealed significant improvement on perceptions of body image over time following surgery. Follow-up t-tests revealed that the most significant improvement occurred between pre-surgery and 6 months post-surgery. Although smaller, the change between 6 months post-surgery and 1 year post-surgery was also significant. CONCLUSION: While RYGBP results in numerous medical and physical benefits, this study reveals that there are also dramatic improvements in perceived body image, demonstrating the impact of this surgery on a patient's psychosocial health.
Adult↗
Hand-assisted laparoscopic surgery for cancer.
Minimally invasive surgical approaches were designed to enhance quality of care and improve patient outcome by minimizing postoperative pain, shortening hospital stay, reducing costs, and facilitating early return to work and presurgical lifestyle. The hand-assisted laparoscopic approach for resection of cancer is still in its formative stage, and this review places it in proper perspective within the context of minimally invasive surgery currently being performed for both benign and malignant disease. The review also outlines the potential advantages and disadvantages, techniques, and site-specific procedures of hand-assisted laparoscopic surgery for cancer.
Abdominal Neoplasms↗