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After cholecystectomy a certain number of patients continue to suffer from abdominal symptoms or develop such symptoms postoperatively. The aim of this study was to compare the prevalence of postcholecystectomy symptoms with open... more
After cholecystectomy a certain number of patients continue to suffer from abdominal symptoms or develop such symptoms postoperatively. The aim of this study was to compare the prevalence of postcholecystectomy symptoms with open cholecystectomy during the prelaparoscopic era and those with laparoscopic cholecystectomy 4 years after introduction of the laparoscopic technique. Between July 1988 and June 1989 a total of 163 consecutive patients with elective open cholecystectomy and between September 1994 and August 1995 a total of 234 consecutive patients with elective laparoscopic cholecystectomy were prospectively evaluated using a standard questionnaire about preoperative symptoms, diagnostic modalities, and intraoperative findings. After a minimum of 12 months the patients were interviewed by telephone. Since the introduction of the minimal invasive technique the number of cholecystectomies performed at our institution increased. There was no significant difference in the prevalence of postcholecystectomy symptoms found after the open procedure compared with laparoscopic cholecystectomy: 90% of patients after open and 94% after laparoscopic cholecystectomy had no or only minor symptoms.
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Laparoscopic sleeve gastrectomy (LSG) is gaining popularity, but studies reporting long-term results are still rare. The objective of this study was to present the 5-year outcome concerning weight loss, modification of co-morbidities, and... more
Laparoscopic sleeve gastrectomy (LSG) is gaining popularity, but studies reporting long-term results are still rare. The objective of this study was to present the 5-year outcome concerning weight loss, modification of co-morbidities, and late complications. This is a retrospective analysis of a prospective cohort with a minimal follow-up of 5 years. A total of 68 patients underwent LSG either as primary bariatric procedure (n = 41) or as redo operation after failed laparoscopic gastric banding (n = 27) between August 2004 and December 2007. At the time of LSG, the mean body mass index (BMI) was 43.0 ± 8.0 kg/m(2), the mean age 43.1 ± 10.1 years, and 78% were female. The follow-up rate was 100% at 1 year postoperatively, 97% after 2 years, and 91% after 5 years; the mean follow-up time was 5.9 ± 0.8 years. The average excessive BMI loss was 61.5% ± 23.4% after 1 year, 61.1% ± 23.4% after 2 years, and 57.4% ± 24.7% after 5 years. Co-morbidities improved considerably; a remission of type 2 diabetes could be reached at 85%. The following complications were observed: 1 leak (1.5%), 2 incisional hernias (2.9%), and new-onset gastroesophageal reflux in 11 patients (16.2%). Reoperation due to insufficient weight loss was necessary in 8 patients (11.8%). LSG was effective 5.9 years postoperatively with an excessive BMI loss of almost 60% and a considerable improvement or even remission of co-morbidities.
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Deficiencies in micronutrients after bariatric operations are frequent, despite routine supplementation. Main outcome measures were pre- and postoperative frequency of nutrient deficiencies and success rate of their treatment. Between... more
Deficiencies in micronutrients after bariatric operations are frequent, despite routine supplementation. Main outcome measures were pre- and postoperative frequency of nutrient deficiencies and success rate of their treatment. Between 5/2004 and 12/2006, 136 patients (m:f = 0:4) with an average body mass index of 45 (35-58) kg/m(2) and age of 53 (21-66) years were prospectively analysed. Laparoscopic Roux-Y-gastric bypass (LRYGB) was performed in 86 patients and laparoscopic sleeve gastrectomy (LSG) was performed in 50 patients. The patients were examined before surgery as well as 3, 6, 12, 24, 30, and 36 months postoperatively using a standard protocol including laboratory tests. The mean follow-up time was 24.4 (12-40) months; the follow-up rate was 100%. Prior to surgery, 57% of the patients had at least one deficiency, 23% of whom had vitamin D(3) deficiency. Frequent postoperative deficiencies after LSG were zinc, vitamin D(3), folic acid, iron, and vitamin B(12); after LRYGB, vitamin B(12), vitamin D(3), zinc, and secondary hyperparathyroidism. No vitamin B(1) or B(6) deficiencies were found. Calcium levels were normal in all patients. Treatment of the deficiencies was mostly successful. Preoperatively, 57% of morbidly obese patients already had a deficiency. Postoperatively, significantly more vitamin B(12) and vitamin D deficiencies and hyperparathyroidism were found in patients who had undergone LRYGB. After LSG, folate deficiency was more frequent (but not significantly so). Calcium levels were normal in all patients; therefore, parathyroid hormone and vitamin D(3) levels are more sensitive markers for early detection of disorders of calcium metabolism. Iron deficiency anaemia is most efficiently treated by IV therapy.
Research Interests: Folic acid, Prospective studies, Humans, Female, Male, and 22 moreYoung Adult, Zinc, Iron, Body Mass Index, Parathyroid Hormone, Obesity Surgery, Clinical Sciences, Aged, Middle Aged, Early Detection, Adult, Success Rate, Public health systems and services research, Morbid Obesity, Gastric Bypass, Iron Deficiency Anaemia, Vitamin D Deficiency, Laboratory Tests, Laparoscopy, Prospective Study, Laparoscopic Sleeve Gastrectomy, and Avitaminosis
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Research Interests:
Research Interests: Bariatric Surgery, Treatment Outcome, Adolescent, Sleep Apnea, Humans, and 17 moreWeight Loss, Female, Male, Follow-up studies, Body Mass Index, Gastric banding, Obesity Surgery, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Time Factors, Physical Performance, Morbid Obesity, Laparoscopy, and Self Esteem
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We investigated early and midterm results of laparoscopic sleeve gastrectomy (LSG) as an isolated primary and secondary operation after failed gastric banding. Between May 2004 and October 2007, a total of 70 patients (female 77%, mean... more
We investigated early and midterm results of laparoscopic sleeve gastrectomy (LSG) as an isolated primary and secondary operation after failed gastric banding. Between May 2004 and October 2007, a total of 70 patients (female 77%, mean age 43 (21-65) years, mean initial body mass index (BMI) 46 (35-61) kg/m(2)) were prospectively evaluated and operated by LSG. In 41 patients, LSG was performed as a primary operation (group 1) and in 29 patients as a secondary procedure after failed gastric banding (group 2). The overall average follow-up time after LSG was 24 (12-53) months; follow-up rate 1 year after operation was 100%, after 2 years 98%, and after 3 years 95%. There were no intraoperative complications, no conversion with shorter operation time in group 1 (91 vs. 132 min, p = 0.001). Early morbidity of LSG was 5% (major) and 7% (minor); mortality was zero. Average excessive BMI loss after 1 year was 65% (9-127%), after 2 years 63% (13-123%), and after 3 years 60% (9-111%). Midterm morbidity was 13%. There was no significant difference between the two groups regarding early and midterm morbidity, reoperation rate for complications (11.4%), or insufficient weight loss (7%). LSG is a safe bariatric procedure with good weight loss in the first 3 years postop. It can be used as an isolated initial treatment and as a secondary treatment after failed gastric banding. However, in the absence of long-term results, we suggest LSG to be performed only in controlled trials.
Research Interests: Treatment Outcome, Humans, Weight Loss, Female, Male, and 13 moreYoung Adult, Body Mass Index, Gastric banding, Obesity Surgery, Clinical Sciences, Aged, Middle Aged, Body mass index (BMI), Adult, Public health systems and services research, Randomized Controlled Trial, Group, and Laparoscopic Sleeve Gastrectomy
A 33-year-old, morbidity obese woman underwent a laparoscopic Roux-en-Y gastric bypass in November 2004. She presented 18 months later with a history of recurrent pain in the upper region of the abdomen and severe vomiting. Radiologic and... more
A 33-year-old, morbidity obese woman underwent a laparoscopic Roux-en-Y gastric bypass in November 2004. She presented 18 months later with a history of recurrent pain in the upper region of the abdomen and severe vomiting. Radiologic and endoscopic evaluations revealed wall thickening in the transverse colon and a solid tumor near the liver. Therefore, a sonography-guided biopsy of the tumor was performed. Cytopathological examination revealed actinomycosis. Thus, therapy with penicillin was started, after which the parameters associated with the infection decreased. The symptoms persisted, however, and the decision was made to operate on the patient to resect the abdominal masses. Nearly 90% of the masses could be removed. Histological analysis showed a fibro-productive inflammation with an actinomycotic etiology. Antibiotic therapy with penicillin was continued for 6 months. Actinomycosis must be considered in the differential diagnosis of patients with abdominal mass, wall thickening of the intestine, and other such symptoms, including abdominal pain following bariatric surgery, even many years after the intervention.
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Page 1. JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 10, Number 1, 2000 Mary Ann Liebert, Inc. The Learning Curve of Laparoscopic Cholecystectomy and Changes in Indications: One Institutions's Experience ...
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Zusammenfassung. Zwischen 1984 und 1996 wurde an unserer Klinik bei der Behandlung der morbiden Adipositas die Gastroplastik nach Mason an 14 Patienten im Alter von 40 (26–48) Jahren, Body-mass-Index (BMI) 48 (37–71) kg/m2, bergewicht... more
Zusammenfassung. Zwischen 1984 und 1996 wurde an unserer Klinik bei der Behandlung der morbiden Adipositas die Gastroplastik nach Mason an 14 Patienten im Alter von 40 (26–48) Jahren, Body-mass-Index (BMI) 48 (37–71) kg/m2, bergewicht 67 (41–116) kg durchgefhrt. Seit Dezember 1996 wenden wir das justierbare laparoskopische „gastric banding“ (Lap-band) an: 73 Patienten im Alter von 39 (22–64) Jahren, BMI 45
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Summary. Aims: We studied the nature and frequency of symptoms 1 year after laparoscopic cholecystectomy in order to define pre- and perioperative factors that influence the long-term outcome. Method: Between September 1994 and August... more
Summary. Aims: We studied the nature and frequency of symptoms 1 year after laparoscopic cholecystectomy in order to define pre- and perioperative factors that influence the long-term outcome. Method: Between September 1994 and August 1995 we prospectively evaluated 268 patients undergoing laparoscopic cholecystectomy using a standard questionnaire. After an average of 16 months (12–25 months) the patients were asked about