Biomedical subjects

William B Inabnet

Publications and source records attributed to William B Inabnet.

24 records · Page 2Linked to original sources

PubMed2002

The efficacy of sestamibi parathyroid scintigraphy for directing surgical approaches based on modified interpretation criteria.

PURPOSE: With the increasing use of targeted parathyroidectomy, the accuracy of sestamibi parathyroid scintigraphy (SPS) in determining the best surgical approach has become more clinically relevant than its sensitivity for detecting all abnormal glands. The reported accuracy of SPS does not represent the true efficacy of SPS for directing targeted parathyroidectomy, because many authors reported accuracy on the basis of abnormal glands. The authors assessed the efficacy of SPS based on modified interpretation criteria to determine specifically whether SPS influences the surgeon's choice of a targeted versus a conventional approach to parathyroidectomy. METHODS: The authors reviewed the SPS studies (both dual-isotope subtraction and Tc-99m sestamibi dual-phase techniques) performed in 80 patients with primary hyperparathyroidism. All patients had surgery with histologic diagnoses, intraoperative PTH assays, and clinical follow-up. RESULTS: Of 75 patients with solitary adenomas, 9 SPS studies were negative, equivocal, or showed two or more foci, and 66 studies showed a solitary focus on the correct side. Of these 66 studies, 63 showed a lesion in the correct quadrant (e.g., superior or inferior) and 3 predicted the correct side only but a wrong quadrant. The positive-predictive value of SPS was 100% for correctly identifying the side of the adenoma (thus correctly directing unilateral surgery) and 95.5% for correctly identifying the quadrant of the solitary adenoma. CONCLUSION: The positive-predictive value of SPS for directing the surgical approach (but not for detecting individual lesions) that reveals a single focus is very high based on our modified interpretation criteria.

Adenoma↗

PubMed2002

Laparoscopic Roux-en-Y gastric bypass with remnant gastrectomy for focal intestinal metaplasia of the gastric antrum.

BACKGROUND: Inaccessibilility of the excluded stomach after isolated gastric bypass prevents postoperative evaluation and treatment of disorders of the gastric remnant. Bleeding complications, peptic ulcer disease, and gastric malignancy in the gastric remnant have all been reported. We report a patient with morbid obesity and focal intestinal metaplasia in the antrum of the stomach that was treated with laparoscopic Roux-en-y gastric bypass (LRYGBP) with remnant gastrectomy. CASE REPORT: A 46-year-old female with a long history of morbid obesity presented with a BMI of 47 kg/m2. Preoperative upper endoscopy revealed focal intestinal metaplasia. Since intestinal metaplasia is a risk factor for gastric cancer, a LRYGBP with remnant gastrectomy was performed. CONCLUSIONS: LRYGBP with remnant gastrectomy is a safe and cost-effective treatment for morbidly obese patients with focal intestinal metaplasia of the stomach.

Anastomosis, Roux-en-Y↗

PubMed2002

Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients.

BACKGROUND: 10 to 25% of patients undergoing bariatric surgery will require a revision, either for unsatisfactory weight loss or for complications. Reoperation is associated with a higher morbidity and has traditionally been done in open fashion. The purpose of this study was to determine the safety and efficacy of reoperative surgery using a laparoscopic approach. METHODS: A retrospective review of medical records over a 22-month period was conducted. 27 consecutive obesity surgery patients, who had undergone a laparoscopic revision, were identified. 26 of the 27 patients were women. The average age was 40.3 years (range 20 to 58 years) and average original preoperative body mass index (BMI) was 51.6 kg/m2 (range 42 to 66.5). The 27 primary bariatric operations consisted of vertical banded gastroplasty (12), gastric band placement (9) and gastric bypass (6). 17 of them were open procedures. After the primary surgery, the lowest average BMI was 37.6 kg/m2 (range 21 to 52), which increased to 42.7 kg/m2 (range 29 to 56) before reoperation. 24 of the 27 reoperations were indicated for insufficient weight loss. On average, revision was undertaken 52 months after the primary procedure (range 12 to 240 months). RESULTS: 24 of the 27 laparoscopic reoperations were conversions to a gastric bypass. A second reoperation was indicated for insufficient weight loss on four occasions. In one case, conversion to open surgery was required. The average operative time was 232 +/- 18.5 minutes (range 120 to 480) and length of hospital stay was 3.7 days (range 1 to 9). 22% percent of patients (6) experienced complications, including pneumothorax, gastric remnant dilation, gastrojejunostomy stenosis, port-site hernia and protein malnutrition. There was no mortality in the study. The average BMI was 35.9 kg/m2 (range 27 to 45.5) 8 months after surgery (range 1 to 22 months). Compared with a preoperative BMI of 42.7 kg/m2, the weight loss was statistically significant (p < 0.001). CONCLUSION: Our results compare favorably with those reported for open reoperative bariatric surgery. A laparoscopic approach may be considered a feasible and safe alternative to an open operation.

Adult↗

PubMed2002

Ambulatory radioguided parathyroidectomy.

Primary hyperparathyroidism (HPT) is a common disease that occurs in one of 500 women and one of 2,000 men over the age of 40. In 85% to 90% of patients, primary HPT is caused by a solitary parathyroid adenoma. Recent advances in evaluation and surgical management of HPT, including improved localization techniques and intraoperative parathyroid hormone (PTH) monitoring, have permitted a more targeted approach to parathyroid surgery.

Humans↗

PubMedDate not supplied

Laparoscopic vs. open biliopancreatic diversion with duodenal switch: a comparative study.

Biliopancreatic diversion with duodenal switch (BPD-DS) is a well-known emerging open procedure that appears to be as effective as other bariatric operations and has been shown to provide excellent long-term weight loss. Therefore we looked at the safety and efficacy of the laparoscopic BPD-DS procedure compared to open BPD-DS in superobese patients (body mass index >60). A retrospective study of 54 superobese patients (body mass index >60) was carried out from July 1999 to June 2001: laparoscopic BPD-DS in 26 patients and open BPD-DS in 28 patients. Median preoperative body weight was 189.8 kg (range 155.1 to 271.2 kg) in the laparoscopic BPD-DS group and 196.5 kg (range 160.3 to 298.9 kg) in the open BPD-DS group. Median body mass index was 66.9 kg/m(2) in the laparoscopic group and 68.9 kg/m(2) in the open group. The two groups were compared by means of the unpaired t test, which yielded the following results: Major morbidity occurred in six patients (23%) in the laparoscopic BPD-DS group and in five patients (17%) in the open BPD-DS group (P = 0.63). There were two deaths in the laparoscopic BPD-DS group (7.6% mortality) and one death (3.5% mortality) in the open BPD-DS group (P = 0.51). Preoperative comorbidity was improved in eight patients in the laparoscopic BPD-DS group and two patients in the open BPD-DS group (P < 0.02). Laparoscopic BPD-DS is a technically feasible procedure that results in effective weight loss similar to the open procedure. However, both open and laparoscopic BPD-DS procedures are associated with appreciable morbidity and mortality in the superobese population. Additional studies are needed to determine the best surgical treatment for superobesity.

Adult↗

PubMedDate not supplied

Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane.

BACKGROUND: Laparoscopically performed sleeve gastrectomy may be employed as an adjunct to biliopancreatic diversion with duodenal switch (BPD-DS), to induce early satiety and weight loss in morbidly obese patients. Complications from this gastric procedure include staple-line leakage or hemorrhage. The efficacy of a staple-line buttressing material, an absorbable polymer membrane (Seamguard, Gore), in reducing these complications, was investigated. METHODS: A prospective consecutive series of 20 patients who underwent a laparoscopic sleeve gastrectomy in conjunction with BPD-DS were studied. In 10 patients, the absorbable polymer membrane was integrated into the gastric linear staple-line (group A). In a control group of 10 patients, a conventional linear stapling system was used (group B). The following data were recorded: demographics, intraoperative blood loss, staple-line leakage and hospital stay. RESULTS: Demographic profile was similar in both groups. Operative data, including type, duration and strategy of operation as well as surgeon's experience were well matched. Peroperative blood loss (120 ml vs 210 ml) was significantly higher in group B (P <0.05). Median length of hospital stay was 3.8 days (range 2-8 days) in group A and 4.6 days (range 4-12 days) in group B. There was no mortality. Morbidity was encountered in 3 patients (all group B), including 2 staple-line hemorrhages (10%) and 1 subphrenic abscess (5%). CONCLUSION: These early results may show that Seamguard reduces staple-line hemorrhage and leakage. This may have contributed to shorter hospital stay, decreased costs and lower morbidity after laparoscopic bariatric surgery.

Absorbable Implants↗