Gastrogastric herniation: An unusual complication following greater curve plication for the treatment of morbid obesity: Case report.
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ABSTRACT:
SUBMITTER: Alhaj A
PROVIDER: S-EPMC8606705 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Transseptal puncture (TSP) is performed to access the left side of the heart from the venous circulation. Performed under fluoroscopy with echocardiographic guidance, it is a procedure associated with complications. Pneumopericardium leading to cardiac tamponade is rare following TSP. We present 3 cases of pneumopericardium during TSP and its identification, probable mechanism, and management. (Level of Difficulty: Advanced.).
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Project description:BackgroundBariatric surgery is more effective in the management of morbid obesity and related comorbidities than is conservative therapy. Pylorus-preserving single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-SG) is a modified duodenal switch technique. Gastric plication (GP) is an alternate to SG.MethodsMorbidly obese (BMI of > 40, or > 35 in the presence of diabetes or prediabetes) patients were recruited and operated on to perform SADI with GP. Complications related to surgery were recorded to assess the feasibility of the procedure. Weight-loss outcomes were analysed to determine efficacy. Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was recorded after 1 year of follow-up, and test scales were used to describe physiological phenomena.ResultsSeventeen middle-aged (mean: 40 years) patients were involved in our study; 15 of them were females. The mean duration of surgery was 205 min. There were no complications of conversion, death, bleeding, VTE or 30-day readmission to hospital. We did experience CD4a (pulmonary insufficiency due to chronic lung disease) and a CD3b (anastomosis leakage treated laparoscopically) complications. Vomiting occurred in three cases (CD1). Obesity-related comorbidities showed favourable resolution rates (77.8% for hypertension, 81.2% for dyslipidaemia, 100% for diabetes at the 1-year follow-up). Weight-loss outcomes were favourable (53.20 EWL%, and 35.58 TWL% at 1-year follow-up). Greater weight loss caused significantly higher levels of Depression (t(13.958) = - 2.373; p = 0.00; p < 0.05) and Low Positive Emotions (t(13.301) = - 2.954; p = 0.00; p < 0.05) and Introversion/Low Positive Emotionality (t(13.408) = - 1.914; p = 0.02; p < 0.05) in MMPI-2 data.ConclusionAccording to our safety study, SADI-GP is a promising malabsorptive procedure, but a long-term high-volume case series or a randomised controlled trial is necessary to evaluate complication rates and weight-loss outcomes. Emotional dysregulation is common among bariatric surgery patients according to personality inventory data; therefore, psychological follow-up and psychotherapeutic support are necessary for weight-loss maintenance.
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Project description:Laparoscopic gastric greater curvature plication (LGGCP) is a restrictive bariatric procedure without gastrectomy. However, limited literature on effectiveness of gastric plication exists.We assessed LGGCP's efficacy, effects on associated comorbidities, safety and the rate of complications, and patient satisfaction with LGGCP's outcomes among morbidly obese patients.Analysis of retrospectively data collected from medical records of 26 patients who had undergone LGGCP at Hamad General Hospital, Qatar, during 2011-2012.Most patients (92%) were Qatari nationals. The sample's mean age was 35.1 years. Mean duration of hospital stay was 3.9 ± 1.2 days. Mean preoperative BMI was 40.7?kg/m2 that decreased at 2 years to 34.6?kg/m2. LGGCP's effects on comorbidities were such that 7.6% of patients experienced resolutions of their comorbidities. There were no mortality or postoperative complications that required reoperation. Six patients (23%) were satisfied with the LGGCP's outcomes while 10 patients (38.5%) underwent sleeve gastrectomy subsequently.LGGCP had acceptable short term weight loss results, exhibited almost no postoperative complications, and improved patients' comorbidities. Despite the durability of the gastric fold, some patients regained weight. Future research may assess the possibility of an increase in the gastric pouch size postplication associated with weight regain.
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Project description:The interatrial septum is a structure with complex embryological development. The true atrial septum is a circumscribed structure, and transgression outside of this area during transseptal puncture may result in entry into the extracardiac space or aorta that may result in a pericardial effusion or cardiac tamponade. (Level of Difficulty: Intermediate.).
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Project description:BackgroundGlycine is a dietary non-essential amino acid that is low in obesity and increases following bariatric surgery. However, the exact mechanism responsible remains unclear and it is unknown whether hypoglycinemia is a cause or consequence of insulin resistance.ObjectiveUsing multiple isotopically labeled tracers, we aimed to determine the underlying kinetic changes responsible for hypoglycinemia in obesity by: 1) Comparing glycine kinetics between participants with morbid obesity (BMI ≥ 32.5 kg/m2) to those with healthy weight (BMI < 25 kg/m2), and 2) Comparing glycine kinetic changes in participants with morbid obesity after bariatric surgery.Methods[1,2-13C2] glycine, [2,3,3-2H3] serine, and [2H5] phenylalanine were infused to compare the glycine kinetic parameters between 21 participants with morbid obesity and 21 controls with healthy weight. Participants with morbid obesity then underwent bariatric surgery and 17 were re-studied 6 months later. Data were analyzed by non-parametric methods and presented as median (interquartile range).ResultsCompared to controls, participants with morbid obesity had significantly lower plasma glycine concentrations at 163 (153-171) vs. 201 (172-227) µmol/L and significantly reduced de novo glycine synthesis rate at 86.2 (64.5-111) vs.124 (103-159) µmol·kg LBM-1·h1, p < 0.001. Following surgery, body weight and insulin resistance decreased and this was accompanied by significant increases in plasma glycine concentration to 210 (191-243) µmol/L as well as the de novo glycine synthesis rate to 127 (98.3-133) µmol·kg LBM-1·h-1, p < 0.001 vs. baseline.ConclusionHypoglycinemia in participants with morbid obesity was associated with impaired de novo glycine synthesis. The increase in plasma glycine concentration and de novo glycine synthesis plus the marked improvement in insulin resistance after bariatric surgery suggest that hypoglycinemia may be secondary to impaired glycine synthesis because of obesity-induced insulin resistance.Clinical trial registration[https://tinyurl.com/6wfj7yss], identifier [NCT04660513].
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Project description:BackgroundObesity is a medical condition that is known for increased body mass index (BMI). It is also associated with chronic low level inflammation. Obesity disrupts the immune-metabolic homeostasis by changing the secretion of adipocytes. This affects the end-organs, and gives rise to several diseases including type 2 diabetes, asthma, non-alcoholic fatty liver diseases and cancers. These diseases are known as co-morbid diseases. Several studies have explored the underlying molecular mechanisms of developing obesity associated comorbid diseases. To understand the development and progression of diseases associated with obesity, we need a detailed scenario of gene interactions and the distribution of the responsible genes in human system.ResultsObesity and Co-morbid Disease Database (OCDD) is designed for relating obesity and its co-morbid diseases using literature mining, and computational and systems biology approaches. OCDD is aimed to investigate the genes associated with comorbidity. Several existing databases have been used to extract molecular interactions and functional annotations of each gene. The degree of co-morbid associations has been measured and made available to the users. The database is available at http://www.isical.ac.in/~systemsbiology/OCDD/home.php.ConclusionsThe main objective of the database is to derive the relations among the genes that are involved in both obesity and its co-morbid diseases. Functional annotation of common genes, gene interaction networks and key driver analyses have made the database a valuable and comprehensive resource for investigating the causal links between obesity and co-morbid diseases.
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Project description:The patient with obesity represents unique challenges to the medical community and, in the setting of pregnancy, additional risks to both mother and fetus. This document will focus on the risks and considerations needed to care for the women with obesity and her fetus during the antepartum, intrapartum, and immediate postpartum stages of pregnancy. Specific attention will be given to pregnancy in the setting of class III and super morbid obesity.
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Project description:BACKGROUND:The first reported case of cardiac herniation was in 1948 and occurred following pericardiectomy during a lung cancer resection. Although rare, this potentially fatal surgical complication may occur following any operation in which a pericardial incision or resection is performed. The majority of literature on cardiac herniation involves case reports after intrapericardial pneumonectomy. Currently, there are no reports of cardiac herniation after thymectomy with pericardial resection. CASE PRESENTATION:A 44-year-old Asian female with symptomatic myasthenia gravis was referred for thymectomy. Originally thought to have Bell's Palsy, her symptoms began with right eyelid drooping and facial weakness. Over time, she developed difficulty holding her head up, upper extremity weakness, difficulty chewing and dysarthria. These symptoms worsened with activity. She was found to have positive acetylcholine receptor binding antibody on her myasthenia gravis panel. A preoperative CT scan demonstrated a 3.5?cm?×?2?cm anterior mediastinal mass along the right heart border and phrenic nerve. A complete thymectomy, via right-sided robotic-assisted approach was performed en bloc with a portion of the right phrenic nerve and a 4?cm?×?4?cm portion of pericardium overlying the right atrium and superior right ventricle. Upon undocking of the robot and closure of the port sites, the patient became acutely hypotensive (lowest recorded blood pressure 43/31?mmHg). The camera was reinserted and demonstrated partial cardiac herniation through the anterior pericardial defect toward the right chest. An emergent midline sternotomy was performed and the heart was manually reduced. The patient's hemodynamics stabilized. A vented Gore-Tex 6?cm?×?6?cm patch was sewn along the pericardial edges with interrupted 4-0 prolene to close the pericardial defect. CONCLUSION:This potentially fatal complication, although rare, should always be considered whenever there is hemodynamic instability entry or resection of the pericardium during surgery. We now routinely sew in a pericardial patch using our robotic surgical system for any defect over 3?cm?×?3?cm that extends from the mid- to inferior portions of the heart.
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