Biomedical subjects

Rodrigo Gonzalez

Publications and source records attributed to Rodrigo Gonzalez.

At least 19 recordsLinked to original sources

PubMed2006

Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity.

BACKGROUND: Anastomotic leaks are a dreaded complication of bariatric surgery. The objective of this study was to describe the clinical presentation and outcomes of treatment in patients who develop anastomotic leaks after Roux-en-Y gastric bypass for obesity. STUDY DESIGN: Prospectively collected data on 3,018 consecutive patients who underwent Roux-en-Y gastric bypass in 4 tertiary referral centers were reviewed. RESULTS: Sixty-three patients (2.1%) developed anastomotic leaks (open, 2.1%; laparoscopic, 2.1%) at a median of 3 days (range 0 to 28 days) after Roux-en-Y gastric bypass. Symptoms and signs included tachycardia (72%), fever (63%), or abdominal pain (54%). Upper gastrointestinal series and CT demonstrated leaks in only 17 of 56 (30%) and 28 of 50 (56%) patients, respectively; when done jointly, both studies were negative in 30% of patients. The 68 anastomotic leaks occurred at the gastrojejunostomy (49%), excluded stomach (25%), jejunojejunostomy (13%), gastric pouch (9%), and uncertain location (4%). Forty patients (63%) required 58 reoperations for drainage of intraabdominal collections (55%), repair of anastomotic defects (34%), or revision of the leaking anastomosis (11%), with an overall morbidity of 53% and mortality of 10%. Nonoperative treatment was successful in 23 of 26 patients, with an overall morbidity of 61% and no mortality (p=NS versus operative). Operative treatment was more common in patients with hypotension or oliguria (p < 0.01). CONCLUSIONS: Lack of specificity in clinical presentation and imaging studies make diagnosing anastomotic leaks challenging, so operative exploration should be part of the diagnostic algorithm. Nonoperative treatment is safe and effective in a subset of patients who exhibit stable hemodynamic parameters and are known to have controlled leaks.

Adult↗

PubMed2006

Complex formation between rhodamine B and poly(sodium 4-styrenesulfonate) studied by 1H-NMR.

A 1H NMR study is presented for the binding of rhodamine B (RB) to the polyanion containing aromatic groups poly(sodium 4-styrenesulfonate) (PSS), which is also evidenced by diafiltration. 1H NMR spectra showed an accentuated upfield shift of proton H6' of the benzoic ring of RB at pH 7, indicating the stacking of RB onto PSS. The corresponding structure is proposed which is in accordance to Hunter and Sanders rules. At pH 2, an upfield shift of the xanthene protons of RB would indicate a highly condensed state for this molecule.

Journal Article↗

PubMed2006

pH dependence of the interaction between rhodamine B and the water-soluble poly(sodium 4-styrenesulfonate).

The binding of rhodamine B (RB) to the polyanion containing aromatic groups poly(sodium 4-styrenesulfonate) (PSS) is studied by separation and spectroscopic techniques at pH between 2 and 7. Significant binding is found at pH below 5, together with a red-shift of the RB maximum of absorbance to 564 nm, and RB fluorescence quenching. The dependence of the pH is related with protonation of RB molecules. Fluorescence quenching is a consequence of a more hydrophobic environment and may occur on territorially or site-specifically bound molecules, and/or on self-aggregated molecules in a hydrophobic polymer domain. Remarkably, the basicity of RB is increased by the influence of the polymer.

Journal Article↗

PubMed2006

Consequences of conversion in laparoscopic colorectal surgery.

INTRODUCTION: Laparoscopic procedures converted to open approaches have been associated with higher complication rates than laparoscopic and open cholecystectomy and appendectomy. Laparoscopic colorectal resections have relatively high conversion rates compared with other laparoscopic procedures. This study was designed to evaluate outcomes of conversions compared with laparoscopic and open colorectal resections. METHODS: We reviewed 498 consecutive colorectal resections performed between 1995 and 2002. Procedures were divided into laparoscopic colorectal resections, open colorectal resections, or conversions. Demographics, underlying disease, type of procedure performed, and operative outcomes were compared between groups. RESULTS: Of the 238 laparoscopic procedures performed, 182 were completed laparoscopically and 56 (23 percent) required conversion; 260 were performed open. Conversions were associated with greater blood loss (200 (range, 50-750) vs. 100 (range, 30-900) ml), longer time to first bowel movement (82 (range, 40-504) vs. 72 (range, 12-420) hr), and longer length of stay (6 (range, 2-67) vs.. 5 (range, 2-62) days) than the laparoscopic colorectal resections group. There was no difference in operative time, transfusion requirements, intraoperative and postoperative complications, or mortality between conversions and laparoscopic colorectal resections. Conversions resulted in fewer patients requiring transfusions (4 vs. 14 percent), shorter time to first bowel movement (82 (range, 40-504) vs. 93 (range, 24-240) hr), and shorter length of stay (6 (range, 2-67) vs. 7 (range, 2-180) days) than in the open colorectal resections group. There were no differences in complications or mortality between the conversion group and the open colorectal resections group. CONCLUSIONS: Laparoscopic colorectal resections has a relatively high conversion rate; however, the converted cases have outcomes similar to open colorectal resections. In fact, the converted group required fewer blood transfusions than the open group. Experience and good judgment are fundamental for timely conversion of a laparoscopic procedure to open to decrease complication rates. Despite a high conversion rate, surgeons should consider laparoscopic colorectal resections, because even when necessary, conversion does not result in poorer outcomes than laparoscopic colorectal resections or open colorectal resections.

Colectomy↗

PubMed2006

Aortic atresia or severe left ventricular outflow tract obstruction with ventricular septal defect: results of primary biventricular repair in neonates.

BACKGROUND: Aortic atresia or severe aortic stenosis and left ventricular outflow tract obstruction is a frequent component of complex congenital heart disease. Aortic atresia or severe aortic stenosis and left ventricular outflow tract obstruction with two adequate ventricles is sometimes treated by Norwood palliation followed by late biventricular repair. We reviewed our experience with primary biventricular repair in this group of neonates. METHODS: Retrospective review identified 17 neonates (10 males) with aortic atresia or severe left ventricular outflow tract obstruction with ventricular septal defect and an adequate left ventricle undergoing primary biventricular repair between 1986 and 2002. Mean age was 7.7 +/- 2.9 days, weight 3.3 +/- 0.7 kg, and body surface area 0.21 +/- 0.04 kg/m2. Associated anomalies included arch hypoplasia, 7 (41%); aortic atresia, 7 (41%); and coarctation, 5 (29%). Results are reported as mean +/- standard deviation. RESULTS: Median follow-up was 6 years (range, 1 to 17.7 years). Three of the 17 (18%) died within 30 days. There were no deaths in this series since 1992. Nine patients (38.9%) required one reoperation, 7 of which were for conduit stenosis, 1 for left ventricular outflow tract obstruction, and 1 for residual ventricular septal defect with left ventricle-to-right atrium shunt. Freedom from death at 10 years was 82% by Kaplan-Meier estimate. CONCLUSIONS: Excellent long-term survival can be achieved by primary biventricular repair as corroborated by our survival rate of 82%. Primary biventricular repair is an effective operation for aortic atresia and severe left ventricular outflow tract obstruction with adequate sized left ventricle that avoids interstage attrition associated with Norwood palliation and is our procedure of choice.

Aortic Valve↗

PubMed2005

Relationship between tissue ingrowth and mesh contraction.

Contraction is a well-documented phenomenon occurring within two months of mesh implantation. Its etiology is unknown, but it is suggested to occur as a result of inadequate tissue ingrowth into the mesh and has been associated with hernia recurrence. In continuation of our previous studies, we compared tissue ingrowth characteristics of large patches of polyester (PE) and heavyweight polypropylene (PP) and their effect on mesh contraction. The materials used were eight PE and eight PP meshes measuring 10 x 10 cm2. After random assignment to the implantation sites, the meshes were fixed to the abdominal wall fascia of swine using interrupted polypropylene sutures. A necropsy was performed three months after surgery for evaluation of mesh contraction/shrinkage. Using a tensiometer, tissue ingrowth was assessed by measuring the force necessary to detach the mesh from the fascia. Histologic analysis included inflammatory and fibroblastic reactions, scored on a 0-4 point scale. One swine developed a severe wound infection that involved two PP meshes and was therefore excluded from the study. The mean area covered by the PE meshes (87 +/- 7 cm2) was significantly larger than the area covered by the PP meshes (67 +/- 14 cm2) (p = 0.006). Tissue ingrowth force of the PE meshes (194 +/- 37 N) had a trend toward being higher than that of the PP meshes (159 +/- 43 N), although it did not reach statistical significance. There was no difference in histologic inflammatory and fibroblastic reactions between mesh types. There was a significant correlation between tissue ingrowth force and mesh size (p = 0.03, 95% CI: 0.05-0.84). Our results confirm those from previous studies in that mesh materials undergo significant contraction after suture fixation to the fascia. PE resulted in less contraction than polypropylene. A strong integration of the mesh into the tissue helps prevent this phenomenon, which is evidenced by a significant correlation between tissue ingrowth force and mesh size.

Animals↗

PubMed2005

Operative technique for converting a failed vertical banded gastroplasty to Roux-en-Y gastric bypass.

BACKGROUND: Bariatric surgeons are increasingly encountering patients with failed weight-loss operations. Conversion from vertical banded gastroplasty (VBG) to Roux-en-Y gastric bypass (RYGB) is the most common revisional operation in our practice. We reviewed our experience in converting from VBG to RYGB using a basic five-step surgical technique. STUDY DESIGN: We reviewed data on all patients undergoing revisional surgery for failed VBG, defined as patients with body mass index >/=35 kg/m(2), weight gain, poor control of comorbidities, staple-line dehiscence, or band-specific complications. The five basic steps include identification of the band, delineation of the extent of the pouch, division of the stomach, preparation of the Roux limb, and completion of the cardiojejunostomy. RESULTS: We have undertaken 28 conversions from VBG to RYGB. Median age was 51 years (range 27 to 65 years), preoperative body mass index was 40 kg/m(2) (range 20 to 58 kg/m(2)), and 25 patients (89%) were women. Indications for revision were band-related complications (13 patients), staple-line disruption (9 patients), and inadequate weight loss (6 patients). Median operative time was 185 minutes (range 105 to 465 minutes), estimated blood loss was 450 mL (range 100 to 2,500 mL), postoperative complications occurred in 6 patients (21%), and length of hospitalization was 5 days (range 3 to 69 days). Median postoperative body mass index was 32 kg/m(2) (range 20 to 41 kg/m(2)) at a followup time of 16 months (range 1 to 32 months). CONCLUSIONS: The technique described facilitates the operative approach to patients with failed VBG, providing guidelines for safe dissection and division of the gastric pouch for conversion to RYGB. Revisional bariatric operations are technically difficult and are associated with relatively higher complication rates than those reported for primary operations.

Anastomosis, Roux-en-Y↗

PubMed2005

Laparoscopic revision of bariatric procedures: is it feasible?

Reoperative bariatric surgery is required in 10 per cent to 20 per cent of patients secondary to weight regain or complications of the previous procedure. This study evaluates the feasibility of performing the revision procedure laparoscopically. A retrospective review of all patients undergoing revision of a previous weight loss procedure between October 1998 and November 2003 was conducted. Demographics, indications for surgery, operative findings, and complications were reviewed. Thirty-nine revisions were performed in 37 patients. Indications for revision were failure to lose weight (22), gastric outlet stricture (10), refractory gastroesophageal reflux (GERD) (6), and blind loop syndrome (1). All 39 procedures were revised to Roux-en-Y gastric bypass (RYGBP), with 18 open revisions (OR) and 21 laparoscopic revisions (LR). Ten of the 21 LR (48%) were converted to an open procedure due to adhesions or unclear anatomy. Early complications requiring operation were noted in five procedures (two OR, three LR). Nine patients (seven OR, two LR) required surgery at least 3 months following their revision. One patient died (LR). The difference in body mass index (kg/m2) (BMI) pre- and post-op was 43.3+/-9.9 versus 37.4+/-9.2, P = 0.01 (follow-up 5 months), but no significant BMI differences between LR and OR patients were seen. Revisional bariatric surgery is associated with more complications requiring surgery early in the laparoscopic population versus more late complications in those approached open. Revisional bariatric surgery can be approached laparoscopically and with acceptable morbidity comparable to patients whose revision is approached open.

Adult↗

PubMed2005

Components separation technique and laparoscopic approach: a review of two evolving strategies for ventral hernia repair.

When faced with large ventral hernias, surgeons frequently must choose between higher incidence of recurrence after primary repair and higher incidence of wound complications after repair with mesh. The aim of this study is to compare early outcomes between laparoscopic repair (LR) and components separation technique (CST), two evolving strategies for the management of large ventral hernias. We reviewed 42 consecutive patients who underwent CST and 45 consecutive patients who underwent LR of ventral hernia defects of at least 12 cm2. Demographics, hernia characteristics, and short-term outcomes were compared between groups. Patients in the LR group were younger (53 +/- 2 vs 68 +/- 2 years, P < 0.0001), had greater body mass index (34 +/- 2 vs 29 +/- 1 kg/m2, P = 0.02), and had larger hernia defects (318 +/- 49 vs 101 +/- 16 cm2, P < 0.0001) than patients in the CST group. The LR resulted in shorter length of hospital stay (4.9 +/- 0.9 vs 9.6 +/- 1.8 days, P < 0.0001), lower incidence of ileus (7% vs 48%, P < 0.0001), and lower incidence of wound complications (2% vs 33%, P < 0.001) than the CST. Both techniques resulted in similar operative times, transfusion requirements, and mortality. Recurrences occurred in 7 per cent of patients at mean follow-up of 16 months in the CST group and 0 per cent at mean follow-up of 9 months after LR. The LR may have a short-term advantage over the CST in terms of incidence of ileus, wound complications, and hospital stay. Because of their unique advantage over traditional hernia repairs, both techniques may play a significant role in the future treatment of large ventral hernias. Adequate training will be essential for the safe and effective implementation of these techniques within the surgical community.

Aged↗

PubMed2005

Amelioration of gastroesophageal reflux symptoms following Roux-en-Y gastric bypass for clinically significant obesity.

Symptoms of gastroesophageal reflux disease (GERD) are frequent in patients with clinically significant obesity and are reported to improve after Roux-en-Y gastric bypass (RYGB). The purpose of this study is to determine timing and duration of improvement of GERD symptoms in patients undergoing RYGB. Prospectively collected data from patients who underwent RYGB from January 1998 to August 2004 were analyzed. Patients answered a standardized questionnaire pre- and postoperatively inquiring about frequency of GERD symptoms (none, one episode/ week, one episode/day, more than one episode/day) and medication use. Of 606 patients undergoing RYGB, 239 patients (39%) reported GERD symptoms preoperatively (mean age 43 +/- 1 years; body mass index 51 +/- 1 kg/m2). Of these, 89 per cent of patients reported improved at 3 months post-op and 94 per cent of patients 9 months post-op (P < 0.001). Medication usage decreased from 30 per cent to 3 per cent by 3 months and 5 per cent beyond 9 months (P < 0.001). Percentage of excess weight loss was 18 +/- 1 per cent and 75 +/- 2 per cent at 3 and 9 months, respectively. Symptoms of GERD significantly improve and use of antireflux medications is reduced after RYGB independent of weight loss. RYGB may be the treatment of choice for GERD in obese patients.

Adult↗

PubMed2004

Pregnancy and delivery after antireflux surgery.

BACKGROUND: Concerns have been raised that subsequent pregnancy after antireflux surgery (ARS) may predispose to wrap disruption or herniation and adversely affect outcomes. Some surgeons withhold ARS in women of childbearing age for fear of this, but outcomes in this population have not been reported. METHODS: All childbearing-age women who underwent ARS for gastroesophageal reflux disease (GERD) between January 1991 and July 2000 were asked to complete a detailed questionnaire. Patients with subsequent pregnancies (SP) after ARS were compared with patients without subsequent pregnancies (NP). RESULTS: Ninety-five of the 118 patients (81%) completed the questionnaire at a mean follow-up of 4.9 years. Fifteen patients had 19 subsequent pregnancies after undergoing ARS, and retching and/or vomiting were reported during 13 of the pregnancies (69%). Preoperative incidence of complicated-GERD including strictures (11% vs. 20%), Barrett's esophagus (19% vs. 13%), esophagitis (36% vs. 33%), and ulceration (4% vs. 0%)-were similar between the nonpregnant and pregnant groups. Incidence of postoperative moderate to severe esophageal (7% vs. 8%) and extraesophageal symptoms (0% vs. 6%) were similar between the SP and NP groups. Postoperative prevalence of antisecretory medications was similar in SP and NP groups (13% and 23%, respectively). The incidence of fundoplications redone did not reach statistical difference between the NP (11%) and SP (0%) groups. Long-term outcomes and failure rates were similar in both groups, except the SP group reported greater overall satisfaction with ARS. CONCLUSIONS: Women of childbearing age have a high incidence of complicated GERD, which may contribute to higher-than-expected rates of symptomatic and anatomic fundoplication failures than first-time ARS. Subsequent pregnancies do not adversely affect outcomes after ARS.

Adolescent↗

PubMed2004

Extensive preoperative testing is not necessary in morbidly obese patients undergoing gastric bypass.

Morbidly obese patients are considered at high risk for perioperative complications and often undergo extensive testing for preoperative clearance. We analyzed prospectively collected data from 193 patients undergoing weight loss surgery between November 2000 and November 2002. Preoperative chest x-ray examination, pulmonary function tests, noninvasive cardiac testing, and blood work were performed routinely. Preoperative testing identified abnormalities on eight chest x-ray films (4%) and 29 electrocardiograms (15%), none of which required preoperative intervention. Spirometry was abnormal in 41 patients (21%); logistic regression identified preexisting asthma as predictive of obstructive physiology (odds ratio [OR] 3.3; 95% confidence interval [CI] 1.2 to 8.9), and body mass index as predictive of restrictive physiology (OR 1.1; 95% CI 1.01 to 1.2). Arterial blood gases identified only one case of severe hypoxemia requiring intervention. Mild hypoxemia was associated with increasing age (OR 14.5; 95% CI 1.8 to 114). Echocardiography demonstrated four abnormalities (2%); previous history of cardiac disease was the only risk factor (OR 14.5; 95% CI 1.8 to 114). Complete blood count did not identify 84% and 50% of the patients with iron (n=31) and vitamin B(12) (n=12) deficiencies, respectively. Age, body mass index, and history of asthma were associated with abnormal pulmonary function tests and previous cardiac disease with abnormal cardiac testing. These tests are not mandatory as a routine preoperative evaluation and can be used selectively on the basis of medical history.

Adult↗

PubMed2004

Management of incidental ovarian tumors in patients undergoing gastric bypass.

BACKGROUND: Ovarian disease is common in obese women and is usually not screened during routine preoperative evaluation in patients undergoing bariatric surgery. Consequently, surgeons may encounter previously undiagnosed adnexal tumors during bariatric operations. The aim of this study is to report our experience with incidental ovarian tumors in patients during Roux-en-Y gastric bypass (RYGBP). METHODS: Prospectively collected data on all consecutive patients undergoing RYGBP for clinically significant obesity from July 1998 to September 2003 were reviewed for patients with incidental gynecological tumors. Details of operative treatment and outcomes are reported herein. RESULTS: 460 women underwent RYGBP during the study period. 52 (11%) had a previous hysterectomy and/or bilateral oophorectomy and were excluded from the study. 12 ovarian masses, median tumor size 11 cm (range 4-65 cm) were found in 10 women (2.5%) during 6 open and 4 laparoscopic RYGBPs. Mean age was 40+/-9 years and mean BMI was 58+/-12 kg/m(2). Resection of 9 benign cystic lesions and 2 malignant lesions was undertaken. One patient with polycystic ovary syndrome did not undergo resection. The RYGBP was completed in all but 2 patients who, by appearance and intraoperative frozen biopsy, had evidence of malignancy. No additional morbidity resulted from the added gynecological procedure. Based on these results, an algorithm for the treatment of incidental gynecological tumors is suggested. CONCLUSIONS: Although infrequent, incidental ovarian tumors may be discovered in patients undergoing bariatric surgery, emphasizing the importance of thorough exploration of the abdominal cavity. Consultation with a gynecologist is warranted in most instances, and treatment should be on a patient-by-patient basis, especially in women of child-bearing age.

Adult↗

PubMed2004

Does setting specific goals and providing feedback during training result in better acquisition of laparoscopic skills?

The aim of this study was to evaluate whether setting specific goals and providing feedback stimulates trainees to improve their laparoscopic skills. Two groups of eight fourth-year medical students practiced on a MIST-VR trainer, a black box laparoscopic suturing trainer, and computer-based training modules for 30 minutes, twice a week for 3 weeks. A precourse assessment of laparoscopic and open suturing skills and performance of MIST-VR tasks was obtained. Students in group A were given specific goals to achieve and were provided feedback. Group B was given no specific goals or feedback. At the end of the course, seven different tasks and skills were evaluated and subjectively scored during a laparoscopic cholecystectomy in an animal laboratory. A higher number of students in group A completed 10 or more repetitions in the MIST-VR than in group B. The groups showed no difference in final MIST-VR or overall scores in the animal laboratory. The only different scores between groups were for the use of the nondominant hand (NDH). The initial scores in the acquired cut task (ACT) in the MIST-VR correlated well with the performance in the animal laboratory. Setting goals and providing feedback tended to motivate students to practice more compared with the self-directed group. There was no difference in final MIST-VR scores or the performance in the animal laboratory, except for the NDH. The best predictor of performance was initial ACT score.

Clinical Competence↗

PubMed2004

Laparoscopic approach reduces likelihood of perioperative complications in patients undergoing adrenalectomy.

Laparoscopy has been reported advantageous over the conventional open technique for adrenalectomy. However, most comparative series include the relatively more challenging cases in the open group. The aim of this study is to assess the actual role of laparoscopy in reducing perioperative complications compared to open surgery in patients undergoing adrenalectomy. Between January 1992 and December 2002, we performed 148 adrenalectomies in 138 patients. Depending on the approach, patients were divided into laparoscopic (LA) or open adrenalectomy (OA) groups. Demographics, tumor characteristics, operative data, and outcomes were analyzed. Linear and logistic regressions identified factors influencing perioperative outcomes. Multivariate-adjusted logistic regression assessed independent relationship between factors and perioperative outcomes. A total of 78 cases were performed laparoscopically and 70 open. Patients were matched for age and sex. Tumor size was smaller (3 +/- 2 vs 5 +/- 3 cm), operative time was shorter (133 +/- 65 vs 165 +/- 100 min), estimated blood loss was less (114 +/- 152 vs 350 +/- 417 cc), length of stay was shorter (3 +/- 2 vs 7 +/- 3 days), and overall complication rate was lower (7% vs 20%) in the LA compared to the OA group. The incidence of cancer in tumors > or = 6 cm (31%) was higher than in those < 6 cm (4%). All patients with cancer underwent OA. LA was the only factor independently associated with a decreased likelihood of intraoperative bleeding and postoperative pulmonary complications. Large and malignant adrenal tumors are more frequently removed through an open approach. However, this fact has no influence on the advantages of the LA over the OA. Laparoscopy reduces perioperative adrenalectomy perioperative complication rates. It has a positive impact on intraoperative bleeding and postoperative pulmonary complications.

Adrenal Gland Diseases↗

PubMed2003

Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques.

HYPOTHESIS: Although perceived as a more technically demanding and time-consuming technique, the hand-sewn gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass (RYGB) is associated with fewer complications and lower costs than stapled techniques. DESIGN: A retrospective medical record review of prospectively collected data. SETTING: University hospital. PATIENTS: One hundred eight consecutive patients undergoing laparoscopic RYGB between January 1, 1999, and December 31, 2001. INTERVENTION: Three techniques were compared: hand-sewn anastomosis (HSA), circular-stapled anastomosis (CSA), and linear-stapled anastomosis (LSA). MAIN OUTCOME MEASURES: Operative costs, including the cost of stapling devices, the cost of sutures, and operative times, were compared. Rates of anastomotic strictures, leaks, marginal ulcers, bleeding, and wound infections were determined. RESULTS: Eighty-seven patients underwent HSA; 13, CSA; and 8, LSA. Supply costs per patient were higher for CSA ($955) and LSA ($435) than for HSA ($2) (P<.001). The mean +/- SEM operative time for laparoscopic RYGB was longer when performing CSA than HSA or LSA (285 +/- 22 vs 215 +/- 8 and 204 +/- 28 minutes, respectively; P<.001). Stricture rates were higher after CSA than HSA and LSA (4 [31%] of 13 patients vs 3 [3%] of 87 patients and 0 of 8 patients, respectively; P<.01). The wound infection rate was higher after CSA than HSA and LSA (3 [23%] of 13 patients vs 1 [1%] of 87 patients and 0 of 8 patients, respectively; P<.001). There was no difference in anastomotic bleeding, and no anastomotic leaks occurred. CONCLUSIONS: In this experience, hand-sewn gastrojejunostomy during laparoscopic RYGB reduced operating room supply costs and was completed faster than stapled techniques. However, these differences may reflect the learning curve because these techniques were used early in our experience. Lower postoperative stricture and wound infection rates seem to be the primary benefits of the HSA technique.

Anastomosis, Roux-en-Y↗

PubMed2003

Comparison of tissue integration between polyester and polypropylene prostheses in the preperitoneal space.

Tissue integration and implant characteristics of various biomaterials commonly used for inguinal hernia repair have not been studied extensively. The aim of this study is to compare behavior and tissue response between two new polyester prostheses and a commonly used polypropylene (PP) mesh. The polyester prostheses utilized were polyester flat (PF) and polyester soft three-dimensional (PS); the PP mesh utilized was Marlex. Eight randomly assigned 4 x 4-cm2 pieces of two different meshes were fixed in the preperitoneal space with a centrally placed single suture. Gross evaluation included shrinkage and stiffness. Histological evaluation included amount of fibrous and fat encapsulation, connective tissue, foreign-body reaction, neovascularization, hemorrhage, necrosis, and exudate. Evaluations were graded on a zero to four scale. The area and the area ratio were measured using a calibrated micrometer. PP mesh resulted in more fibrous encapsulation and stiffness than PF and PS prostheses. PP also resulted in less connective tissue formation and foreign-body reaction than PF and PS prostheses. There was no difference in fat encapsulation, necrosis, hemorrhage, or exudate between prostheses. Both polyester prostheses (PF and PS) have better tissue integration than the PP mesh, as evidenced by the higher amount of connective tissue and lower extent of fibrous encapsulation.

Animals↗

PubMed2003

Gastric bypass for morbid obesity in patients 50 years or older: is laparoscopic technique safer?

Some physicians have considered age > or = 50 years as a relative contraindication for bariatric surgery. Recent reports demonstrated the safety and efficacy of Roux-en-Y gastric bypass (RYGB) in this patient subgroup, but comparisons between laparoscopic technique (LT) and open technique (OT) have not been reported. A review of 52 patients > or = 50 years old who underwent RYGB between January 1999 and April 2002 was conducted. Demographics, operative data, and outcomes were assessed. Preoperative and postoperative renal and hepatic functions, electrolytes, anemia studies, and hematology results were compared. Patients were divided into LT and OT groups and operative outcomes were compared. The percentage of excess body weight loss was 66 +/- 4 per cent at mean follow-up of 12 months. Blood samples drawn after a mean of 8 +/- 2 months revealed no postoperative metabolic alterations. RYGB resulted in a reduction of the number of patients with hyperglycemia, hypertension, degenerative joint disease, gastroesophageal reflux disease, and continuous positive airway pressure-dependent sleep apnea (P < 0.05). The LT resulted in fewer intensive care unit admissions and shorter length of stay. RYGB is safe and well tolerated in patients > or = 50 years resulting in no renal, hepatic, or electrolytic alterations. Weight loss and control of obesity-related comorbidities are satisfactory. The LT results in fewer intensive care unit admissions and shorter length of stay than the OT.

Age Factors↗