Acupuncture Anxiolytic Effects on Physiological and Psychological Assessments for a Clinical Trial.

In a randomized controlled trial we examined the effect of acupuncture on anxiety of the adolescent football players prior to the competition using psychological and physiological markers. A total of 45 athletes were equally allocated to either acupuncture group, sham group, or wait-list control group. Thereafter, all participants were asked to complete an anxiety questionnaire before and after the intervention.

Intestinal injury secondary to an umbilical piercing.

Background: Body piercing has become increasingly popular throughout the world and may cause unanticipated complications during surgery.

Methods: We describe the case of a 35-y-old woman with hepatocellular carcinoma who underwent a diagnostic laparoscopy for metastatic disease evaluation.

Results: An early intestinal injury occurred upon abdominal entry and introduction of pneumoperitoneum.

Preoperative predictors of weight loss following bariatric surgery: systematic review.

Background: Obesity affects 32% of adults in the USA. Surgery generates substantial weight loss, but 20-30% fails to achieve successful weight loss. Our objective was to identify preoperative psychosocial factors associated with weight loss following bariatric surgery.

Patient behaviors associated with weight regain after laparoscopic gastric bypass.

Background: Patients undergoing gastric bypass lose substantial weight, but 20% regain weight starting at 2 years after surgery. Our objective was to identify behavioral predictors of weight regain after laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods: We retrospectively surveyed 197 patients for factors predictive of weight regain (≥15% from lowest weight to weight at survey completion).

Behavioral factors associated with successful weight loss after gastric bypass.

Patients undergoing bariatric surgery lose substantial weight (> or = 50% excess weight loss [EWL]), but an estimated 20 per cent fail to achieve this goal. Our objective was to identify behavioral predictors of weight loss after laparoscopic Roux-en-Y gastric bypass. We retrospectively surveyed 148 patients using validated instruments for factors predictive of weight loss.

Exercise following bariatric surgery: systematic review.

The contribution of physical activity on the degree of weight loss following bariatric surgery is unclear. To determine impact of exercise on postoperative weight loss. Medline search (1988-2009) was completed using MeSH terms including bariatric procedures and a spectrum of patient factors with potential relationship to weight loss outcomes.

Early experience with laparoscopic sleeve gastrectomy as a single-stage bariatric procedure.

Laparoscopic sleeve gastrectomy (LSG) as a single-stage restrictive bariatric procedure is becoming increasingly popular, especially in patients who are high risk and/or superobese. Between November 21, 2006, and September 30, 2008, 42 patients underwent LSG at our institution. Average age was 47 +/- 11 years, average body mass index was 54 +/- 10 kg/m2, and 62 per cent were female.

Does weight loss immediately before bariatric surgery improve outcomes: a systematic review.

Background: Preoperative weight loss before bariatric surgery has been proposed as a predictive factor for improved patient compliance and the degree of excess weight loss achieved after surgery. In the present study, we sought to determine the effect of preoperative weight loss on postoperative outcomes.

Methods: A search of MEDLINE was completed to identify the patient factors associated with weight loss after bariatric surgery.

Early jejunojejunostomy obstruction after laparoscopic gastric bypass: case series and treatment algorithm.

Background: To review our experience with early jejunojejunostomy obstruction (JJO) at a large academic teaching hospital and provide a management algorithm. Early JJO is a known and often overlooked complication of laparoscopic Roux-en-Y gastric bypass.

Methods: From 2003 to 2007, 1097 patients underwent laparoscopic Roux-en-Y gastric bypass at our institution.

Laparoscopic gastric bypass at a large academic medical center: lessons learned from the first 1000 cases.

Bariatric surgery is an effective and durable treatment for morbid obesity in properly selected patients. Surgical outcomes and patient management methods should routinely be reviewed to improve patient care and maintain long-term effectiveness of the bariatric operation. Over a 5-year period, 1096 laparoscopic Roux-en-Y gastric bypass operations were performed at our institution.

Succinylcholine: a drug to avoid in bariatric surgery.

Succinylcholine is a paralytic agent regularly utilized in anesthesia. There are numerous adverse effects of succinylcholine ranging from mild to fatal; one such effect is succinylcholine myalgia. We report the case of a 34-year-old woman who received succinylcholine while undergoing laparoscopic Roux-en-Y gastric bypass and later developed succinylcholine myalgia leading to a prolonged hospital stay and subsequent pneumonia.

Postoperative CPAP and BiPAP use can be safely omitted after laparoscopic Roux-en-Y gastric bypass.

Background: Obstructive sleep apnea (OSA) is prevalent in the morbidly obese population. The need for routine preoperative testing for OSA has been debated in bariatric surgery publications. Most investigators have advocated the use of continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) in the postoperative setting; however, others have reported pouch perforations or other gastrointestinal complications as a result of their use.

Laparoscopic transgastric removal of eroded adjustable band: a novel approach.

Gastric erosion is a well-known complication of laparoscopic adjustable gastric band (LAGB) placement for morbid obesity. We describe a novel approach for the removal of an eroded band through a laparoscopic gastrotomy with subsequent intraluminal division and removal of the band. A 67-year-old woman with a body mass index of 35.

Selective approach to use of upper gastroesophageal imaging study after laparoscopic Roux-en-Y gastric bypass.

Background: Many institutions routinely perform upper gastroesophageal imaging (UGI) studies on their laparoscopic Roux-en-Y gastric bypass (LRYGB) patients after surgery. We had routinely studied our patients with UGI on postoperative day 1 to rule out an anastomotic leak or obstruction, until recently when we abandoned this practice. As previously reported, we found that routine UGI did not contribute significantly to patient care.

Improved outcomes using a systematic and evidence-based approach to the laparoscopic Roux-en-Y gastric bypass in a single academic institution.

No standardized approach exists for laparoscopic Roux-en-Y gastric bypass (LRYGB). At a newly instituted bariatric surgery program, four experienced laparoscopic surgeons used the systematic and evidence-based approach consisting of multidisciplinary preoperative evaluation, screening, and education; standardized operative technique; inpatient clinical pathway; and close postoperative follow-up. The outcomes were subsequently analyzed to determine if this approach improved the morbidity and mortality.

Routine postoperative upper gastroesophageal imaging is unnecessary after laparoscopic Roux-en-Y gastric bypass.

Routine early postoperative upper gastroesophageal imaging (UGI) is often used in laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures to confirm anastomotic patency and to exclude leaks. The aim of our study was to assess the usefulness of this practice. From January 2003 to November 2004, 322 LRYGB cases were performed using linear staplers for the gastrojejunostomy and jejuno-jejunostomy anastomoses.

Gallbladder management during laparoscopic Roux-en-Y gastric bypass surgery: routine preoperative screening for gallstones and postoperative prophylactic medical treatment are not necessary.

In the bariatric surgery literature, the optimum approach to the gallbladder is controversial. Recommendations range from concomitant cholecystectomy to selective screening and postoperative medical prophylaxis. At our institution, we have taken a highly selective approach where patients are not routinely screened for gallstones, nor are they medically treated postoperatively with bile salts.