Experience with over 3,000 open and laparoscopic bariatric procedures: Multivariate analysis of factors related to leak and resultant mortality

Fernandez, Antony; DeMaria, Eric J.; Tichansky, David S.; Kellum, John M.; Wolfe, Luke; Meador, Jill G.; Sugerman, Harvey J.

doi:10.1007/s00464-003-8926-y

Cited by 335 publications

(176 citation statements)

References 17 publications

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“…Increased risk factors for early mortality include: revisional surgery, biliopancreatic diversion Ͼ gastric bypass (GBP) Ͼ laparoscopic adjustable gastric banding, high BMI (usually Ͼ 50 kg/m 2 ), and male gender (5-7). Data linking type 2 diabetes, OSA, and HTN to risk of early mortality are less consistent (6,8).…”

Section: Multidisciplinary Care: Operative Riskmentioning

confidence: 98%

“…Approximately two-thirds of early postoperative mortality from WLS is associated with anastomotic leaks and PEs (5)(6)(7)(8)(9)(10). Potential long-term problems include not only those seen after any abdominal procedure, such as ventral hernia, but also those specific to WLS procedures, e.g., gastric outlet obstruction, marginal ulceration, bowel obstruction, protein malnutrition, and vitamin deficiencies (3).…”

Section: Introductionmentioning

confidence: 99%

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Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

et al. 2005

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Criteria for patient selection and multidisciplinary evaluation and treatment of the weight loss surgery patient. Obes Res. 2005;13:234 -243. Objective: To provide evidence-based guidelines for patient selection and to recommend the medical and nutritional aspects of multidisciplinary care required to minimize perioperative and postoperative risks in patients with severe obesity who undergo weight loss surgery (WLS). Research Methods and Procedures: Members of the Multidisciplinary Care Task Group conducted searches of MEDLINE and PubMed for articles related to WLS in general and medical and nutritional care in particular. Pertinent abstracts and literature were reviewed for references. Multiple searches were carried out for various aspects of multidisciplinary care published between 1980 and 2004. A total of 3000 abstracts were identified; 242 were reviewed in detail. Results: We recommended multidisciplinary screening of WLS patients to ensure appropriate selection; preoperative assessment for cardiovascular, pulmonary, gastrointestinal, endocrine, and other obesity-related diseases associated with increased risk for complications or mortality; preoperative weight loss and cessation of smoking; perioperative prophylaxis for deep vein thrombosis and pulmonary embolism (PE); preoperative and postoperative education and counseling by a registered dietitian; and a well-defined postsurgical diet progression. Discussion: Obesity-related diseases are often undiagnosed before WLS, putting patients at increased risk for complications and/or early mortality. Multidisciplinary assessment and care to minimize short-and long-term risks include: comprehensive medical screening; appropriate pre-, peri-, and postoperative preparation; collaboration with multiple patient care disciplines (e.g., anesthesiology, pulmonary medicine, cardiology, and psychology); and long-term nutrition education/counseling.

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Section: Multidisciplinary Care: Operative Riskmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

et al. 2005

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“…Of particular concern are venous thromboembolism (66,(68)(69)(70) and sepsis. The latter occurs especially as a result of infection of the gastric band, anastomotic leak, and wound infection (52,(70)(71)(72).…”

Section: Postoperative Complications and Difficultiesmentioning

confidence: 99%

“…Leaks are difficult to diagnose, a heart rate above 120 beats/min and respiratory distress/failure are the most common manifestations of anastomotic leak (68,70,85). It should be noted that anastomotic leaks after bariatric surgery frequently become clinically apparent after discharge (86).…”

Section: Postoperative Complications and Difficultiesmentioning

confidence: 99%

Surgical treatment of obesity

Bult¹,

Dalen²,

Müller³

2008

European Journal of Endocrinology

240

141

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More than half of the European population are overweight (body mass index (BMI) O25 and !30 kg/m 2 ) and up to 30% are obese (BMIR30 kg/m 2 ). Being overweight and obesity are becoming endemic, particularly because of increasing nourishment and a decrease in physical exercise. Insulin resistance, type 2 diabetes, dyslipidemia, hypertension, cholelithiasis, certain forms of cancer, steatosis hepatis, gastroesophageal reflux, obstructive sleep apnea, degenerative joint disease, gout, lower back pain, and polycystic ovary syndrome are all associated with overweight and obesity. The endemic extent of overweight and obesity with its associated comorbidities has led to the development of therapies aimed at weight loss. The long-term effects of diet, exercise, and medical therapy on weight are relatively poor. With respect to durable weight reduction, bariatric surgery is the most effective long-term treatment for obesity with the greatest chances for amelioration and even resolution of obesity-associated complications. Recent evidence shows that bariatric surgery for severe obesity is associated with decreased overall mortality. However, serious complications can occur and therefore a careful selection of patients is of utmost importance. Bariatric surgery should at least be considered for all patients with a BMI of more than 40 kg/m 2 and for those with a BMI of more than 35 kg/m 2 with concomitant obesity-related conditions after failure of conventional treatment. The importance of weight loss and results of conventional treatment will be discussed first. Currently used operative treatments for obesity and their effectiveness and complications are described. Proposed criteria for bariatric surgery are given. Also, some attention is devoted to more basic insights that bariatric surgery has provided. Finally we deal with unsolved questions and future directions for research. European Journal of Endocrinology 158 135-145

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“…9,10 A multivariate logistic regression analysis in a study that included more than 3000 patients who underwent LRYGB concluded that ASL was one of the strongest independent risk factors for postoperative death. 11 Fortunately, the incidence of ASL is relatively low at 0.4%-5.2%. [11][12][13][14][15] It is pertinent, however, to mention that experience performing LRYGB plays an important role in lowering the ASL rate, with large retrospective series revealing an almost 40% reduction in ASL as the surgeons became more adept using the technique.…”

Section: Anastomotic or Staple Line Leaksmentioning

confidence: 99%

Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity

Griffith

Birch²,

Sharma³

et al. 2012

Can J Surg

104

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Experience with over 3,000 open and laparoscopic bariatric procedures: Multivariate analysis of factors related to leak and resultant mortality

Abstract: The data suggests that older, heavier male patients with multiple comorbid conditions are at increased risk for leak and mortality. Surgeons early in their learning curve should avoid these high-risk patients to reduce complications.

Cited by 335 publications

References 17 publications

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

Surgical treatment of obesity

Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity

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