Biomedical subjects

Michael Korenkov

Publications and source records attributed to Michael Korenkov.

7 recordsLinked to original sources

PubMed2006

Bariatric surgery.

BACKGROUND/METHODS: Bariatric surgery today is the only effective therapy for morbid obesity. Commonly performed procedures include adjustable gastric banding (AGB) and vertical banded gastroplasty (VBG); variations of Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion or duodenal switch (BPD) and mixed procedures. All these procedures can be performed by open surgery and more recently by laparoscopy. This review discusses key issues in the surgical management of morbid obesity. RESULTS: The two most common bariatric procedures performed worldwide are laparoscopic AGB and laparoscopic RYGB. Controversy exists regarding the best surgical procedure. For example, gastric bypass is the procedure of choice in the United States, while most surgeons in Europe and Australia favor gastric banding. Weight loss decreased according to the procedures performed in following decreasing order: BPD, RYGB, VBG, AGB. CONCLUSION: Concerning the complications and quality of life there is no single operation for morbid obesity without drawbacks. According the currently opinion are gastric restrictive procedures (AGB, VBG) generally considered safe and quick to perform, but the long-term outcome and quality of life, especially with regard to eating patterns, have been questioned. On the other hand the long-term efficacy of AGB can be improved by the development of new band devices. More complex bariatric procedures, such as RYGB or BPD, have a greater potential for serious perioperative complications but are associated with good long-term outcome in terms of weight loss combined with less dietary restriction.

Bariatric Surgery↗

PubMed2006

Is routine preoperative upper endoscopy in gastric banding patients really necessary?

BACKGROUND: Preoperative evaluation for bariatric surgery is complex. Our investigation focused on the necessity for upper gastrointestinal (GI) endoscopy as a routine procedure before performing gastric banding. METHODS: A consecutive series of 145 patients underwent laparoscopic adjustable gastric banding (LAGB). Gastroscopy was performed routinely before LAGB. All patients were interviewed before gastroscopy regarding gastroesophageal symptoms. Gastroscopic findings and the results of the interview were blinded and set in comparison. Furthermore, we analyzed whether upper GI symptoms, BMI, age or gender were predictive parameters for pathological findings on gastroscopy. Small hiatal hernia was not considered a clinically relevant finding. RESULTS: Gastroscopy yielded abnormal findings in only 15 patients (10%). There were 8 patients with hiatal hernia, 4 patients with esophagitis, 1 gastric ulcer, 1 erosive gastritis, and 1 gastric polyp. Abnormal findings on gastroscopy did not correlate with age, BMI, or gender. The 18 patients who reported gastroesophageal symptoms were more likely to have abnormal gastroscopic findings (P<0.001). Gastroesophageal symptoms had a sensitivity of 80% and a specificity of 98% in the prediction of a GI abnormality. CONCLUSIONS: The data suggest that it may not be necessary to continue performing gastroscopy in all patients preparing for gastric banding. The data collected support the policy of a selective use of gastroscopy, only focusing on patients suffering from gastroesophageal symptoms. By following this strategy, the rate of preoperative gastroscopies can be reduced safely by 80%.

Adult↗

PubMed2006

Initial clinical experience with telemetrically adjustable gastric banding.

BACKGROUND: The feasibility and safety of laparoscopic adjustable gastric banding for treatment of morbid obesity has been demonstrated in a large number of studies. Access port-related complications constitute a significant part of all complications related to gastric banding. Further, adjustment of hydraulic gastric bands can be fairly lengthy, uncomfortable, and is not a precise procedure. A study was performed to assess the usefulness and efficacy of a new type of band adjusted telemetrically without the need for an access port. The initial worldwide results of the first telemetrically adjustable gastric band for morbid obesity (EASYBAND EndoArt Medical Technologies, Switzerland) in two German academic centers are described herein. METHODS: EASYBAND is a purely mechanical gastric band, in which adjustment is achieved by means of an embedded micromotor, controlled by an external control unit using telemetry. The exact band diameter is displayed continuously during adjustment on the external control unit screen. Thirty-seven patients, means 36 +/- 8 (range: 22-60) years, 7 (19%) men and 30 (81%) women, with a mean body mass index (BMI) of 44.1 +/- 4.5 (range: 35.6-59.6), were implanted using the standard laparoscopic technique during the period from June 2005 to October 2005. Prospective data were collected on all morbidly obese patients who underwent laparoscopic telemetrically adjustable gastric banding (LTAGB). RESULTS: No serious adverse events occurred during the operative period or immediately postoperatively in relation to the device. A mean of 3.0 +/- 0.6 adjustments per patients were performed during the follow-up schedule at one, three and six months. The band diameter was set to 29 mm (fully open) at implantation, 24.5 mm +/- 0.5 mm at one month, 23.3 mm +/- 0.7 mm at three months, and 23.0 mm +/- 1.0 mm at six months. The mean percent excess weight loss was 10.2% +/- 4.5% at one month, 23.8% +/- 8.8% at three months, and 30.2% +/- 10.5% at six months. CONCLUSION: This initial study shows that the new telemetrically adjustable gastric banding device is implanted and operated safely, allows for atruamatic band adjustments with superior patient comfort, and leads to early excess weight loss comparable to that achieved by other gastric bands. Longer-term follows and larger population studies are needed to establish the final safety and performance profile of the telemetric gastric band.

Adult↗

PubMed2005

Surgery for obesity.

PURPOSE OF REVIEW: Bariatric surgery today is the only effective therapy for morbid obesity. Commonly performed procedures include adjustable gastric banding and vertical banded gastroplasty, variations of the Roux-en-Y gastric bypass, biliopancreatic diversion or duodenal switch, and mixed procedures. This review discusses key issues in the surgical management of morbid obesity. RECENT FINDINGS: The two most common bariatric procedures performed worldwide are laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Controversy exists regarding the best surgical procedure. Weight loss decreases according to the procedures performed in following decreasing order: biliopancreatic diversion, Roux-en-Y gastric bypass, vertical banded gastroplasty, adjustable gastric banding. Concerning the complications and quality of life, there is no single operation for morbid obesity without drawbacks. Cost-effectiveness analyses have demonstrated that bariatric surgery is cost effective at less than 50,000 US dollars/quality-adjusted life years. SUMMARY: According to current opinion, gastric restrictive procedures (adjustable gastric banding, vertical banded gastroplasty) are generally considered safe and quick to perform, but the long-term outcome and quality of life have been questioned. By contrast, the long-term efficacy of adjustable gastric banding can be improved by the development of new band devices. More complex bariatric procedures, such as the Roux-en-Y gastric bypass or biliopancreatic diversion, have a greater potential for serious perioperative complications but are associated with good long-term outcome in terms of weight loss combined with less dietary restriction.

Bariatric Surgery↗

PubMed2004

Reduced colonization and infection with miconazole-rifampicin modified central venous catheters: a randomized controlled clinical trial.

OBJECTIVE: Central venous catheters (CVC) are a major cause of nosocomial bloodstream infections. Catheters modified with miconazole and rifampicin that constantly and slowly release antimicrobial substances are assumed to be beneficial in reducing rates of colonization and catheter-related infections. DESIGN AND SETTING: Prospective controlled non-blinded randomized clinical trial in two German university hospitals. PATIENTS: 223 adult inpatients with CVC between October 2000 and February 2002. Baseline characteristics, APACHE II score and therapeutic interventions were comparable. INTERVENTION: Randomization to receive either a miconazole and rifampicin modified catheter (n=118) or a standard triple-lumen CVC (n=105). MEASUREMENTS, DEFINITIONS: Microbiological evaluation was done after CVC removal. A catheter was considered colonized if growth of > or =15 cfu was found by semi-quantitative roll-plate technique from a proximal or distal catheter segment. A catheter-related infection (CRI) was defined as a colonized catheter with local signs of inflammation. A catheter-related bloodstream infection (CR-BSI) was defined as a colonized catheter with isolation of the same organism from the patient's blood with accompanying clinical signs of infection. RESULTS: A colonization of CVC was observed in six patients (5.1%) with a modified catheter and 38 patients (36.2%) with a standard catheter (P < 0.001). Five patients in the modified group (4.2%) and 18 in the standard group (17.1%) developed CRI (P=0.002). One assumed CR-BSI was detected in the standard group, with none in the modified group. No adverse effects related to the modified catheters and no antimicrobial resistance were observed. CONCLUSION: CVC supersaturated with miconazole and rifampicin were associated with a significantly lower risk for catheter colonization and catheter-related infections compared to standard catheters.

Adolescent↗

PubMed2004

Laparoscopic gastric banding as a universal method for the treatment of patients with morbid obesity.

INTRODUCTION: This study analyzed the influence of potentially negative predictors such as sweet-eating behavior, super-obesity, social and psychological status, family and education situation, intake of sedative drugs, and the distance between hospital and home on the outcome of laparoscopic adjustable gastric banding (LAGB). METHODS: 77 women and 29 men with mean age 40.6 years (28-47) underwent LAGB. Preoperative mean body weight was 146 kg (99-179), and mean BMI was 48.1 kg/m2 (36.4-73.5). The influence of the above-mentioned potentially negative predictors on weight loss was the primary end point. RESULTS: Mean follow-up was 44.6 +/- 19.7 months. Follow-up was possible in all but 6 patients. Median excess weight loss (EWL) was 52.1% (range 28.6-72.2%). Univariate analysis revealed no influence of the investigated negative predictors on the weight reduction. Median EWL in 24 sweet-eater patients was 55.6% compared to 55.4% in 82 non-sweet-eaters (P=0.65). A significant difference in the weight reduction was found between super-obese and non-superobese groups (P <0.001). CONCLUSIONS: LAGB should be recommended without limitation as the operation of choice for morbidly obese patients. Gastric bypass operations should be recommended only in cases of unsuccessful LAGB.

Adult↗

PubMed2002

Esophageal motility and reflux symptoms before and after bariatric surgery.

BACKGROUND: Surgical treatment is the most effective method for weight reduction in morbid obesity. The most common operations are gastric banding and gastric bypass. The effect of these interventions on esophageal function and gastroesophageal reflux symptoms has not been adequately investigated. METHODS: Patients undergoing obesity surgery were prospectively included in an observational study. Before surgery, each of the 53 patients underwent pulmonary function tests, esophageal manometry, and gastroscopy. Drug medication and esophageal symptoms were recorded. "Non-sweet eater" patients with good compliance underwent laparoscopic adjustable gastric banding (LAGB). In "sweet-eating" or non-compliant patients, gastric bypass (GBP) was carried out. RESULTS: Between July 1997 and April 2000, 53 patients (9 males and 44 females) were consecutively operated on. 32 patients (median BMI 46.4 kg/m2 +/- 5.4 SD) received LAGB, and 21 patients (BMI 54.0 kg/m2 +/- 10.7) GBP. Median follow-up was 22 months, and only 3 patients were lost to yearly follow-up. Preoperatively, 6 LAGB patients had reflux symptoms, which postoperatively resolved in 3 of them, while the other 3 noted no change. Three patients who had no preoperative reflux symptoms developed them after LAGB. In the GBP group, no patient had esophageal dysmotility or incompetent esophageal sphincter function pre- or postoperatively. The incidence of postoperative esophageal symptoms was independent of operative technique (Wilcoxon U-Test: p = 0.75). CONCLUSION: The present results do not show any effect of gastric reduction surgery on postoperative esophageal function or gastroesophageal reflux symptoms.

Adult↗