Gastric Bypass, has a better risk-benefit profile than the Band

Rny Gastric Bypass has ** greater weight loss **, ** increased resolution of diabetes **, and ** improved quality of life** than Gastric Band,



RnY Gastric Bypass, has a better risk-benefit profile than the Band.



RnY Gastric Bypass has a similar rate of overall complications and lower rate of reoperations than LB.

Amplify’d from archsurg.ama-assn.org

Vol. 146 No. 2, February 2011   Online Only  • Online First Table of Contents Original Article  • Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Public Health  • Obesity  • Quality of Life  • Surgery  • Surgical Interventions  • Bariatric Surgery  • Gastrointestinal/ Upper Foregut  • Prognosis/ Outcomes  • Endocrine Diseases  • Alert me on articles by topic  Social Bookmarking   What's this? Better Weight Loss, Resolution of Diabetes, and Quality of Life for Laparoscopic Gastric Bypass vs Banding Results of a 2-Cohort Pair-Matched Study Guilherme M. Campos, MD; Charlotte Rabl, MD; Garrett R. Roll, MD; Sofia Peeva, BA; Kris Prado, BA; Jessica Smith, MD; Eric Vittinghoff, PhD Arch Surg. 2011;146(2):149-155. doi:10.1001/archsurg.2010.316 Background  Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding (LB) are the 2 most common operations used to treat morbid obesity, but few controlled comparative studies have reported perioperative and long-term outcomes. Design  Two-cohort pair-matched study. Setting  Academic tertiary referral center. Patients  One hundred consecutive morbidly obese patients treated with LB were pair-matched by sex, race, age, initial body mass index, and presence of type 2 diabetes mellitus with 100 patients who were treated with RYGB. Main Outcome Measures  Perioperative and postoperative complications, reoperations, and 1-year outcomes, including weight loss, type 2 diabetes resolution, and quality of life. Results  The RYGB and LB groups had similar characteristics. One-year outcomes were available for 93 patients in the LB group and 92 in the RYGB group. The overall rate of complications was similar in both groups (11 patients in the LB group [12%] vs 14 in the RYGB group [15%]; P = .83), with a higher rate of early complications (30 days) after RYGB (11 patients [11%] vs 2 [2%] for LB; P = .01) and a higher rate of reoperations after LB (12 patients [13%] vs 2 for RYGB [2%]; P = .009). No deaths occurred. Excess weight loss (36% vs 64%; P < .01), resolution of diabetes (17 patients [50%] vs 26 [76%]; P = .04), and quality-of-life measures were better in the RYGB group. Conclusions  When performed in high-volume centers by expert surgeons, RYGB has a similar rate of overall complications and lower rate of reoperations than LB. With the benefit of greater weight loss, increased resolution of diabetes, and improved quality of life, RYGB, in these circumstances, has a better risk-benefit profile than LB. Read more at archsurg.ama-assn.org

 

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Sitting is killing you.

Sitting is killing you.

Amplify’d from lifehacker.com

nfographics Share this post × Share on Tumblr Email this post The "Sitting Is Killing You" Infographic Shows Just How Bad Prolonged Sitting Is Melanie Pinola — Sitting is killing you. Numerous studies have pointed to the health risks of sitting all day, but here you have in one illustration how prolonged sitting affects our bodies and reminders to interrupt sitting time whenever possible. The human body simply isn't built to sit all day at a desk or for hours vegging out on the couch. Many of us spend more time sitting than sleeping. To avoid the health risks, we need not just 30 minutes of daily exercise, the infographic advises, but taking every opportunity to get up during the day. You don't need adopt a standing desk; there were many great suggestions offered by Lifehacker commenters recently on how to avoid sitting down all day, like placing important items (phone, copier) away from the desk. Sitting Is Killing You | Medical Billing & Coding [via How-To Geek] Read more at lifehacker.com

 

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Creatine is an inexpensive and safe dietary supplement

The benefits to older adults of creatine are substantial,

*can improve quality of life, and

*ultimately may reduce diseases associated with

*muscle loss and

*cognitive dysfunction.



The well documented benefits of creatine supplementation in young adults, including increased lean body mass, increased strength, and enhanced fatigue resistance are particularly important to older adults.



Higher brain creatine is associated with improved neuropsychological performance, and recently,

*creatine supplementation has been shown to increase brain creatine and phosphocreatine.



Subsequent studies have demonstrated that cognitive processing, that is either experimentally (following sleep deprivation) or naturally (due to aging) impaired, can be

*improved with creatine supplementation.



Creatine is an inexpensive and safe dietary supplement that has both peripheral and central effects.

Amplify’d from www.ncbi.nlm.nih.gov

Amino Acids. 2011 May;40(5):1349-62. Epub 2011 Mar 11. Use of creatine in the elderly and evidence for effects on cognitive function in young and old. Rawson ES, Venezia AC. Source Department of Exercise Science, 131 CEH, Bloomsburg University, Bloomsburg, PA, 17815, USA, erawson@bloomu.edu. Abstract The ingestion of the dietary supplement creatine (about 20 g/day for 5 days or about 2 g/day for 30 days) results in increased skeletal muscle creatine and phosphocreatine. Subsequently, the performance of high-intensity exercise tasks, which rely heavily on the creatine-phosphocreatine energy system, is enhanced. The well documented benefits of creatine supplementation in young adults, including increased lean body mass, increased strength, and enhanced fatigue resistance are particularly important to older adults. With aging and reduced physical activity, there are decreases in muscle creatine, muscle mass, bone density, and strength. However, there is evidence that creatine ingestion may reverse these changes, and subsequently improve activities of daily living. Several groups have demonstrated that in older adults, short-term high-dose creatine supplementation, independent of exercise training, increases body mass, enhances fatigue resistance, increases muscle strength, and improves the performance of activities of daily living. Similarly, in older adults, concurrent creatine supplementation and resistance training increase lean body mass, enhance fatigue resistance, increase muscle strength, and improve performance of activities of daily living to a greater extent than resistance training alone. Additionally, creatine supplementation plus resistance training results in a greater increase in bone mineral density than resistance training alone. Higher brain creatine is associated with improved neuropsychological performance, and recently, creatine supplementation has been shown to increase brain creatine and phosphocreatine. Subsequent studies have demonstrated that cognitive processing, that is either experimentally (following sleep deprivation) or naturally (due to aging) impaired, can be improved with creatine supplementation. Creatine is an inexpensive and safe dietary supplement that has both peripheral and central effects. The benefits afforded to older adults through creatine ingestion are substantial, can improve quality of life, and ultimately may reduce the disease burden associated with sarcopenia and cognitive dysfunction. Read more at www.ncbi.nlm.nih.gov

 

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Level I: Evidence; Controlled Prospective Trial; MGB vs RNY

Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass for the Treatment of Morbid Obesity

A Prospective Randomized Controlled Clinical Trial



The Mini-Gastric Bypass is a ** simpler ** and ** safer ** procedure that has

** no disadvantage ** compared with RnY Gastric Bypass



Evidence-based medicine (EBM) or evidence-based practice (EBP) aims to apply the best available evidence gained from the scientific method to clinical decision making.[



Level I: Evidence obtained from at least one properly designed randomized controlled trial. Provides the "current best evidence in making decisions about the care of individual patients"

Amplify’d from www.ncbi.nlm.nih.gov

Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass for the Treatment of Morbid Obesity A Prospective Randomized Controlled Clinical Trial Wei-Jei Lee, MD, PhD,* Po-Jui Yu, RN,† Weu Wang, MD,* Tai-Chi Chen, MD,* Po-Li Wei, MD,* and Ming-Te Huang, MD

Abstract

Objectives: This prospective, randomized trial compared the safety and effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic mini-gastric bypass (LMGBP) in the treatment of morbid obesity. Summary Background Data: LRYGBP has been the gold standard for the treatment of morbid obesity. While LMGBP has been reported to be a simple and effective treatment, data from a randomized trial are lacking. Methods: Eighty patients who met the NIH criteria were recruited and randomized to receive either LRYGBP (n = 40) or LMGBP (n = 40). The minimum postoperative follow-up was 2 years (mean, 31.3 months). Perioperative data were assessed. Late complication, excess weight loss, BMI, quality of life, and comorbidities were determined. Changes in quality of life were assessed using the Gastro-Intestinal Quality of Life Index (GIQLI). Results: There was one conversion (2.5%) in the LRYGBP group. Operation time was shorter in LMGBP group (205 versus 148, P < 0.05). There was no mortality in each group. The operative morbidity rate was higher in the LRYGBP group (20% versus 7.5%, P < 0.05). The late complications rate was the same in the 2 groups (7.5%) with no reoperation. The percentage of excess weight loss was 58.7% and 60.0% at 1 and 2 years, respectively, in the LPYGBP group, and 64.9% and 64.4% in the LMGBP group. The residual excess weight <50% at 2 years postoperatively was achieved in 75% of patients in the LRYGBP group and 95% in the LMGBP group (P < 0.05). A significant improvement of obesity-related clinical parameters and complete resolution of metabolic syndrome in both groups were noted. Both gastrointestinal quality of life increased significantly without any significant difference between the groups. Conclusion: Both LRYGBP and LMGBP are effective for morbid obesity with similar results for resolution of metabolic syndrome and improvement of quality of life. LMGBP is a simpler and safer procedure that has no disadvantage compared with LRYGBP at 2 years of follow-up.  Other Sections▼ Abstract METHODS RESULTS DISCUSSION CONCLUSION REFERENCES Read more at www.ncbi.nlm.nih.gov

 

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"I told you..." Dr. Rutledge

Gluten causes gastrointestinal symptoms in subjects without celiac disease: !!!

Amplify’d from www.medscape.com

Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol.  2011; 106(3):508-14; quiz 515 (ISSN: 1572-0241) Biesiekierski JR; Newnham ED; Irving PM; Barrett JS; Haines M; Doecke JD; Shepherd SJ; Muir JG; Gibson PR Monash University Department of Medicine and Gastroenterology, Box Hill Hospital, Box Hill, Victoria, Australia. OBJECTIVES: Despite increased prescription of a gluten-free diet for gastrointestinal symptoms in individuals who do not have celiac disease, there is minimal evidence that suggests that gluten is a trigger. The aims of this study were to determine whether gluten ingestion can induce symptoms in non-celiac individuals and to examine the mechanism. METHODS: A double-blind, randomized, placebo-controlled rechallenge trial was undertaken in patients with irritable bowel syndrome in whom celiac disease was excluded and who were symptomatically controlled on a gluten-free diet. Participants received either gluten or placebo in the form of two bread slices plus one muffin per day with a gluten-free diet for up to 6 weeks. Symptoms were evaluated using a visual analog scale and markers of intestinal inflammation, injury, and immune activation were monitored. RESULTS: A total of 34 patients (aged 29-59 years, 4 men) completed the study as per protocol. Overall, 56% had human leukocyte antigen (HLA)-DQ2 and/or HLA-DQ8. Adherence to diet and supplements was very high. Of 19 patients (68%) in the gluten group, 13 reported that symptoms were not adequately controlled compared with 6 of 15 (40%) on placebo (P=0.0001; generalized estimating equation). On a visual analog scale, patients were significantly worse with gluten within 1 week for overall symptoms (P=0.047), pain (P=0.016), bloating (P=0.031), satisfaction with stool consistency (P=0.024), and tiredness (P=0.001). Anti-gliadin antibodies were not induced. There were no significant changes in fecal lactoferrin, levels of celiac antibodies, highly sensitive C-reactive protein, or intestinal permeability. There were no differences in any end point in individuals with or without DQ2/DQ8. CONCLUSIONS: "Non-celiac gluten intolerance" may exist, but no clues to the mechanism were elucidated. Read more at www.medscape.com

 

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We Want to Know; How Are You?

We want to know how you are doing, so to encourage you to fillout one of our follow up forms we are going to be giving away an iPad in June to one of the people that fills out our follow up forms.



Please help us understand how you are doing





Dr. Rutledge, Email: DrR@clos.net, 702-714-0011,  www.CLOS.net



http://www.facebook.com/DrRutledge

http://twitter.com/DrRR

http://www.youtube.com/user/DrRRutledge    

Over 1,000 videos, Videos Viewed over  1,800,000 times!



For more information, Consider joining one of our online Groups:

http://minigastricbypassrus.ning.com/

http://health.groups.yahoo.com/group/Mini-Gastric-Bypass/

http://groups.google.com/group/mgbers

Amplify’d from clos.net

Fill out a follow up form and you could win an iPad!!! OK! Here it is: We are offering another Drawing for Free iPad!  To encourage participation in our survey in July we gave away a free iPad to one of the patients that completed this survey. (P.S. the winner was from Canada!)   If you fill out this survey in the next few days we are going to be drawing for another new iPad!   We are particularly interested in survey results rating your surgeon and a new section on heart disease before and after surgery  Tell us what has happened to you since you contacted us. Email questions:   ( https://www.surveymonkey.com/s/mgbfollowup ) Read more at clos.net

 

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High Dose Prilosec Sometimes Better

CONCLUSION: Intravenous standard-dose omeprazole was inferior to high-dose omeprazole in preventing rebleeding after endoscopic haemostasis for peptic ulcer bleeding. Registration number: NCT00519519 (http://www.clinicaltrials.gov). Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Amplify’d from www.medscape.com

MEDLINE Abstract Printer-Friendly Email This Download This processing....   [ Close Window ] Download This MEDLINE Bookends Endnote Papyrus Procite Refman Quickdoc  Format. Information from Industry Your eligible patients could save up to $50 Start Saving Now View This Abstract Online Randomized controlled trial of standard versus high-dose intravenous omeprazole after endoscopic therapy in high-risk patients with acute peptic ulcer bleeding. Br J Surg.  2011; 98(5):640-4 (ISSN: 1365-2168) Chan WH; Khin LW; Chung YF; Goh YC; Ong HS; Wong WK Department of Surgery, Singapore General Hospital, National Heart Centre Singapore, Singapore, Republic of Singapore. gsucwh@sgh.com.sg. BACKGROUND: Rebleeding from peptic ulcers is a major contributor to death. This study compared standard (40-mg intravenous infusion of omeprazole once daily for 3 days) and high-dose (80-mg bolus of omeprazole followed by 8-mg/h infusion for 72 h) in reducing the rebleeding rate (primary endpoint), need for surgery, duration of hospital stay and mortality in patients with peptic ulcer bleeding after successful endoscopic therapy. METHODS: This was a single-institution prospective randomized controlled study based on a postulated therapeutic equivalence of the two treatments. All patients who had successful endoscopic haemostasis of a bleeding peptic ulcer (Forrest classification Ia, Ib, IIa or IIb) were recruited. Informed consent was obtained and patients were randomized to receive standard- or high-dose infusions of intravenous omeprazole. RESULTS: Two (3 per cent) of 61 patients in the high-dose group and ten (16 per cent) of 61 in the standard-dose group exhibited rebleeding, a difference of - 13 (95 per cent confidence interval - 25 to - 2) per cent. The upper limit of the one-sided confidence interval exceeded a predefined equivalence absolute difference of 16 per cent. Equivalence of standard- and high-dose omeprazole in preventing rebleeding was not demonstrated. CONCLUSION: Intravenous standard-dose omeprazole was inferior to high-dose omeprazole in preventing rebleeding after endoscopic haemostasis for peptic ulcer bleeding. Registration number: NCT00519519 (http://www.clinicaltrials.gov). Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Read more at www.medscape.com

 

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Reflux (GERD) from Sleeve and the Band

Among bariatric procedures,

** gastric sleeve ** and

vertical banded gastroplasty were shown to worsen reflux symptoms



** Gastric banding ** is associated with reflux symptoms in a considerable proportion of patients.

Amplify’d from www.ncbi.nlm.nih.gov

Curr Gastroenterol Rep. 2011 Jun;13(3):205-12. Obesity and GERD: Pathophysiology and Effect of Bariatric Surgery. Tutuian R. Source Division of Gastroenterology, University Clinics of Visceral Surgery and Medicine, Bern University Hospital, Inselspital Bern, Bern, Switzerland, radu.tutuian@insel.ch. Abstract Epidemiologic, endoscopic, and pathophysiologic studies document the relationship between obesity and gastroesophageal reflux disease (GERD). Increased body mass index and accumulation of visceral fat are associated with a two- to threefold increased risk of developing reflux symptoms and esophageal lesions. Given this association, many studies were designed to evaluate the outcome of reflux symptoms following conventional and surgical treatment of obesity. Among bariatric procedures, gastric sleeve and banded gastroplasty were shown to have no effect or even worsen reflux symptoms in the postoperative setting. Gastric banding improves reflux symptoms and findings (endoscopic and pH-measured distal esophageal acid exposure) in many patients, but is associated with de novo reflux symptoms or lesions in a considerable proportion of patients. To date, Roux-en-Y gastric bypass is the most effective bariatric procedure that consistently leads to weight reduction and improvement of GERD symptoms in patients undergoing direct gastric bypass and among those converted from restrictive bariatric procedures to gastric bypass. Read more at www.ncbi.nlm.nih.gov

 

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Sleeve Gastrectomy; Another Bad Idea

In the present study, Sleeve Gastrectomy showed persistence of GERD symptoms in patients with GERD preoperatively.



Also, patients who did not have GERD preoperatively had an increased risk of postoperative GERD symptoms after Sleeve!!



Another bad idea by American Bariatric surgeons:

Jejunal ileal bypass = abandoned/failure

Stomach stapling = abandoned/failure

Lapband = abandoned/failure (in Europe and coming to America, I believe it will be abandoned)

RNY = why are Drs trying so many other operations?

Sleeve = 50% failure from reflux or weight regain reported from Europe, I believe it will be abandoned

Amplify’d from www.ncbi.nlm.nih.gov

In the present study, LSG correlated with the persistence of GERD symptoms in patients with GERD preoperatively. Also, patients who did not have GERD preoperatively had an increased risk of postoperative GERD symptoms.

Surg Obes Relat Dis. 2011 Mar 21. [Epub ahead of print] Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Carter PR, Leblanc KA, Hausmann MG, Kleinpeter KP, Debarros SN, Jones SM. Source Midwest Surgical Associates, LaGrange, Illinois. Abstract BACKGROUND: Gastroesophageal reflux disease (GERD) is a common co-morbidity identified in obese patients. It is well established that patients with GERD and morbid obesity experience a marked improvement in their GERD symptoms after Roux-en-Y gastric bypass. Conflicting data exist for adjustable laparoscopic gastric banding and GERD. Laparoscopic sleeve gastrectomy (LSG) has become a popular adjunct to bariatric surgery in recent years. However, very little data exist concerning LSG and its effect on GERD. METHODS: A retrospective chart review was performed of 176 LSG patients from January 2006 to August of 2009. The preoperative and postoperative GERD symptoms were evaluated using follow-up surveys and chart review. RESULTS: Of the 176 patients, 85.7% of patients were women, with an average age of 45 years (range 22-65). The average preoperative body mass index was 46.6 kg/m(2) (range 33.2-79.6). The average excess body weight lost at approximately 6, 12, 24 months was calculated as 54.2%, 60.7%, and 60.3%, respectively. Of the LSG patients, 34.6% had preoperative GERD complaints. Postoperatively, 49% complained of immediate (within 30 d) GERD symptoms, 47.2% had persistent GERD symptoms that lasted >1 month after LSG, and 33.8% of patients were taking medication specifically for GERD after LSG. The most common symptoms were heartburn (46%), followed by heartburn associated with regurgitation (29.2%). CONCLUSION: In the present study, LSG correlated with the persistence of GERD symptoms in patients with GERD preoperatively. Also, patients who did not have GERD preoperatively had an increased risk of postoperative GERD symptoms. Copyright © 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved. PMID: 21429818 [PubMed - as supplied by publisher] Read more at www.ncbi.nlm.nih.gov

 

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Sleeve Gastrectomy; Another Bad Idea

In the present study, Sleeve Gastrectomy showed persistence of GERD symptoms in patients with GERD preoperatively.



Also, patients who did not have GERD preoperatively had an increased risk of postoperative GERD symptoms after Sleeve!!

Amplify’d from www.ncbi.nlm.nih.gov

Obes Surg. 2011 Mar;21(3):295-9. Symptoms of gastroesophageal reflux following laparoscopic sleeve gastrectomy are related to the final shape of the sleeve as depicted by radiology. Lazoura O, Zacharoulis D, Triantafyllidis G, Fanariotis M, Sioka E, Papamargaritis D, Tzovaras G. Source Department of Radiology, University Hospital of Larissa, Larissa, Greece. Abstract BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a primary procedure in selected morbidly obese patients. Like most other bariatric procedures LSG results in alterations of the upper GI anatomy that might affect gastroesophageal reflux postoperatively. The study was conducted to assess the presence of reflux symptoms in patients before and after laparoscopic sleeve gastrectomy and any possible relation of these symptoms to the postoperative gastric anatomy as depicted by gastrografin swallow studies. METHODS: The study included 85 consecutive morbidly obese patients who underwent LSG as a primary bariatric procedure. Patients were evaluated for symptoms of gastroesophageal reflux (heartburn, regurgitation, and vomiting) preoperatively and at 1 and 6 months and 1 year postoperatively. To assess the postoperative gastric anatomy, the gastrografin studies that were routinely performed in all patients on the third postoperative day were retrospectively evaluated. Changes of each one of the reflux symptoms were assessed in relation to the radiological pattern of the gastric sleeve. RESULTS: Three radiological patterns of the gastric sleeve were identified: (a) the tubular (65.9%), (b) the superior pouch (25.9%), and (c) the inferior pouch pattern (8.2%). Patients showed an overall tendency towards relief of heartburn and increase of regurgitation and vomiting postoperatively. However, only changes in regurgitation and vomiting were found to be statistically significant (p < 0.01); interestingly, those were observed in patients with the tubular gastric pattern. CONCLUSIONS: The final shape of the gastric sleeve as depicted by radiological studies seems to have an impact on reflux symptoms after laparoscopic sleeve gastrectomy. Read more at www.ncbi.nlm.nih.gov

 

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Low Revision Rate for the MGB

From January 2001 to December 2009, ** 1322 patients ** (996 women and 326 men, mean age 31.6 ± 9.1 years, mean body mass index 40.2 ± 7.4 kg/m(2)), had ** MGB **



Of the 1322 patients,

** 23 (1.7%) ** required revision surgery during

** a follow-up of 9 years. **



revision was for:

malnutrition in 9

inadequate weight loss in 8

** bile reflux ** in 3 out of 1,322!!!



Conclusion MGB appears to be By Far the best form of long term bariatric surgery.

Amplify’d from www.ncbi.nlm.nih.gov

Surg Obes Relat Dis. 2010 Oct 30. [Epub ahead of print] Revisional surgery for laparoscopic minigastric bypass. Lee WJ, Lee YC, Ser KH, Chen SC, Chen JC, Su YH. Source Department of Surgery, Min-Sheng General Hospital, National Taiwan University, Taipei, Taiwan. Abstract BACKGROUND: Laparoscopic minigastric bypass (LMGB), a sleeved gastric tube with Billroth II anastomosis, has been proposed as an alternative to laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity. However, the data regarding revision surgery after LMGB during long-term follow-up is not clear. METHODS: From January 2001 to December 2009, 1322 patients (996 women and 326 men, mean age 31.6 ± 9.1 years, mean body mass index 40.2 ± 7.4 kg/m(2)), who were enrolled in a surgically supervised weight loss program and had undergone LMGB were included. All the patients received regular yearly follow-up, and all the clinical data were prospectively collected and stored. The reasons and type of surgery for revision surgery were identified and analyzed. RESULTS: The excess weight loss and mean body mass index at 5 years after LMGB was 72.1% and 27.1 ± 4.6 kg/m(2). Of the 1322 patients, 23 (1.7%) had undergone revision surgery during a follow-up of 9 years. The estimated accumulated revision rate of 9 years was 2.69% for LMGB. The most common cause of revision was malnutrition in 9 (39.1%), followed by inadequate weight loss in 8 (34.7%), and intractable bile reflux and dissatisfaction each in 3 (13.0%). The type of revision surgery was LRYGB in 11 (47.8%), sleeve gastrectomy in 10 (43.5%), and conversion to a normal anatomic state in 2 (8.6%). All the revision procedures were performed using a laparoscopic approach, without major complications. Two patients underwent repeat second revision surgery to duodenal switch and biliopancreatic diversion each in 1 patient. All patients had satisfactory results after revision surgery. No patients had undergone revision surgery for internal hernia or ileus during the follow-up period. CONCLUSION: LMGB resulted in significant and sustained weight loss with an acceptably low revision rate at long-term follow-up. Revision surgery after LMGB can be performed using a laparoscopic approach with a low risk. Copyright © 2010 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved. Read more at www.ncbi.nlm.nih.gov

 

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Creatine Helps Prevent Muscle Loss Even When in a Cast. Read more...
http://bit.ly/6dduNx

Creatine Controls Blood Glucose as Well as Metformin (Glucophage)
Read more...
http://bit.ly/6HBXkk

80% of Gastric Bypass patients Vitamin D Defficient
Read more...
http://bit.ly/UdHt7

Why is the Short MGB Good? Longer Operative is independently associated with increased Infectious Complications
http://bit.ly/8IGYAi

Iron Deficiency Anemia and Gastric Bypass
http://bit.ly/6K5A34
Introduction

“Bariatric surgery is an effective treatment for patients with clinically severe obesity. In addition to significant weight loss, it is also associated with improvements in comorbidities. Unfortunately, bariatric surgery also has the potential to cause a variety of nutritional and metabolic complications. These complications are mostly due to the extensive surgically induced anatomical changes incurred by the patient's gastrointestinal tract, particularly with roux-en-Y gastric bypass and biliopancreatic diversion. ...

http://ping.fm/qke7w
Impact of Dexmedetomidine on Analgesic Requirements in Patients after Cardiac Surgery in a Fast-track Recovery Room Setting

http://ping.fm/c4iqe
Effects of television viewing reduction on energy intake

http://ping.fm/0q4Fd
H. pylori and Peptic Ulcer

On this page:

* What is a peptic ulcer?
* What is H. pylori?
* How does H. pylori cause a peptic ulcer?
* What are the symptoms of an ulcer?
* How is an H. pylori-related ulcer diagnosed?
* How are H. pylori peptic ulcers treated?
* Drugs Used to Treat H. pylori Peptic Ulcers
* Can H. pylori infection be prevented?
* Why don’t all doctors automatically check for H. pylori?
* Points to Remember

http://ping.fm/mc9wN

Mini Gastric Bypass Surgeon Costa Rica Carlos Quesada

Mini Gastric Bypass Surgeon from Costa Rica, Dr. Carlos Quesada talks about MGB:

Another trial of the treatment of diabetes the Mini-Gastric Bypass was
roughly TWICE as effective as the Sleeve Gastrectomy

http://ping.fm/Zz1mW

My eye doctor, Evan Wolf, MD, PhD was telling me that I had bad eys with lots of complications. I told him my sugar was better, at 5.7 and I said I was hoping that my eyes had improved and he said "We'll see". So he sits down and shines that bright light in my eye so he can look deep inside and he says, "I can't believe this, all the damage you had, is completely gone! It's like you have new eyes. I've NEVER seen that happen before. He was so excited!!

I did have to get a new prescription though, cause now I need a magnifier for up close, no glasses for the tv or computer and then something for far away if I"m driving.

And he took me off the Acetazolamide. The only med I have to take is the Synthroid.

Good news
Cindy T
Alaska

http://ping.fm/hOojs
Lap Band Less Effective than Stomach Stapling 3
Laparoscopic Adjustable Silicone Gastric Banding vs Laparoscopic Vertical Banded Gastroplasty in Morbidly Obese Patients: Long-Term Results of a Prospective Randomized Controlled Clinical Trial

Level I Evidence: The Lap Band is inferior to the old stomach stapling

http://ping.fm/qlJV6

Lap Band worse than stomach stapling.
Controlled prospective trial shows the old stomach stapling is better than the band!
;-(

Dr. Rutledge,
Like some of the people I have seen on your videos on you tube, I found your name after typing in failed lap-band. I have had my band for 3 years after I let myself be talked into it by my best friend. The vomiting is awful and has almost put a complete stop to my life for weeks on end as I try to get things under control time and time again. My question is do you ever just remove a lap band without doing the MGB surgery? I feel as though I am done with this and am slowly losing my mind as well as my health.
Thank you and thank you for this site which makes me feel not so alone.
J

The Comparative Dose-Response Effects of Melatonin and Midazolam for Premedication of Adult Patients: A Double-Blinded, Placebo-Controlled Study
Mohamed Naguib, MB, BCh, MSc, FFARCSI, MD*, and Abdulhamid H. Samarkandi, MB, BS, KSUF, FFARCSI{dagger}

Departments of Anesthesia, *University of Iowa College of Medicine, Iowa City, Iowa, and {dagger}King Saud University, Riyadh, Saudi Arabia

Address correspondence and reprint requests to Mohamed Naguib, MD, University of Iowa College of Medicine, Department of Anesthesia, 200 Hawkins Dr., 6JCP, Iowa City, Iowa 52242-1009. Address e-mail to mohamed-naguib@uiowa.edu.

We designed this prospective, randomized, double-blinded, placebo-controlled study to compare the perioperative effects of different doses of melatonin and midazolam.

Doses of 0.05, 0.1, or 0.2 mg/kg sublingual midazolam or melatonin or placebo were given to 84 women, approximately 100 min before a standard anesthetic.

Sedation, anxiety, and orientation were quantified before, 10, 30, 60, and 90 min after premedication, and 15, 30, 60, and 90 min after admission to the recovery room.

Psychomotor performance of the patient was evaluated at these times also, by using the digit-symbol substitution test and Trieger dot test.

Patients who received premedication with either midazolam or melatonin had a significant decrease in anxiety levels and increase in levels of sedation preoperatively compared with control subjects.

Patients in the three midazolam groups experienced significant psychomotor impairment in the preoperative period compared with melatonin or placebo.

After operation, patients who received 0.2 mg/kg midazolam premedication had increased levels of sedation at 90 min compared with 0.05 and 0.1 mg/kg melatonin groups. In addition, patients in the three midazolam groups had impairment of performance on the digit-symbol substitution test at all times compared with the 0.05 mg/kg melatonin group.

Premedication with 0.05 mg/kg melatonin was associated with preoperative anxiolysis and sedation without impairment of cognitive and psychomotor skills or affecting the quality of recovery.

Implications:

Premedication with 0.05 mg/kg melatonin was associated with preoperative anxiolysis and sedation without impairment of cognitive and psychomotor skills or affecting the quality of recovery.

http://sites.google.com/a/clos.net/mini/melatonin
Melatonin

Anesth Analg 2007; 105:1263-1271
© 2007 International Anesthesia Research Society
ANESTHETIC PHARMACOLOGY
The Clinical Impact of Preoperative Melatonin on Postoperative Outcomes in Patients Undergoing Abdominal Hysterectomy

Wolnei Caumo, MD, PhD*{dagger}, Fernanda Torres, MSc{ddagger}, Nívio L. Moreira, Jr, MD§, Jorge A. S. Auzani, MD§, Cristiano A. Monteiro, MD§, Gustavo Londero, MD§, Diego F. M. Ribeiro||, and Maria Paz L. Hidalgo, MD, PhD||

From the *Anesthesia Service and Perioperative Medicine at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS); {dagger}Instituto de Ciências Bsicas da Saúde, Pharmacology Department, UFRGS; {ddagger}Multidisciplinary Group of Development of Biological Rhythms of Universidade de São Paulo; §Registrar of Anesthesia Service and Perioperative Medicine at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS); ||Psychiatric Service of Hospital Materno Infantil Presidente Vargas, Hospital de Clínicas de Porto Alegre (HCPA); and ¶Hospital de Clínicas de Porto Alegre (HCPA), Psychiatric Department of School of Medicine, UFRGS, Brazil.

Address correspondence and reprint requests to Dr. Maria Paz Loayza Hidalgo, Castro Alves 167 sala 204, CEP 90430-131 – Porto Alegre, RS, Brazil. Address e-mail to mpaz@cpovo.net.


BACKGROUND: Melatonin has sedative, analgesic, antiinflammatory, antioxidative, and chronobiotic effects. We determined the impact of oral melatonin premedication on anxiolysis, analgesia, and the potency of the rest/activity circadian rhythm.

METHODS: This randomized, double-blind, placebo-controlled study included 33 patients, ASA physical status I–II, undergoing abdominal hysterectomy.

Patients were randomly assigned to receive either oral melatonin 5 mg (n = 17) or placebo (n = 16) the night before and 1 h before surgery.

The analysis instruments were the Visual Analog Scale, the State-Trait Anxiety Inventory, and the actigraphy.

RESULTS:
The number of patients that needed to be treated to prevent one additional patient reporting high postoperative anxiety and moderate to intense pain in the first 24 postoperative hours was 2.53 (95% CI, 1.41–12.22) and 2.20 (95% CI, 1.26–8.58), respectively.

The number-needed-to-treat was 3 (95% CI, 1.35–5.0) to prevent high postoperative anxiety in patients with moderate to intense pain, when compared with 7.5 (95% CI, 1.36–{infty}) in the absence of pain or mild pain.

Also, the treated patients required less morphine by patient-controlled analgesia, as assessed by repeated measures ANOVA (F[1,31] = 6.05, P = 0.02).

The rest/activity cycle, assessed by actigraphy, showed that the rhythmicity percentual of 24 h was higher in the intervention group in the first week after discharge ([21.16 ± 8.90] versus placebo [14.00 ± 7.10]; [t = –2.41, P = 0.02]).

CONCLUSIONS: This finding suggested that

*** preoperative melatonin produced clinically relevant
*** anxiolytic and analgesic effects,
*** especially in the first 24 postoperative hours.

Also, it improved the recovery of the potency of the rest/activity circadian rhythm.

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Lap Band Less Effective than Stomach Stapling
The Lap Band is advertised as an attractive choice for weight loss. A recent controlled prospective randomized trial shows that the LapBand is not as good as the abandoned "Stomach Stapling!"

Obes Surg. 2009 Aug;19(8):1108-15. Epub 2009 Jun 10.Click here to read Links
Laparoscopic adjustable silicone gastric banding vs laparoscopic vertical banded gastroplasty in morbidly obese patients: long-term results of a prospective randomized controlled clinical trial.
Scozzari G, Farinella E, Bonnet G, Toppino M, Morino M.

Digestive Surgery and Center for Minimal Invasive Surgery, Department of Surgery, University of Turin, C.so A.M. Dogliotti 14, 10126, Turin, Italy.

BACKGROUND: Aim of the study is to present long-term results of a prospective randomized single-institution clinical trial comparing laparoscopic adjustable silicone gastric banding (LASGB) with laparoscopic vertical banded gastroplasty (LVBG) in morbid obesity.

METHODS: A total of 100 morbidly obese patients (body mass index 40 to 50 kg/m2) were randomized to LASGB (n=49) or LVBG (n=51) and followed up for a minimum of 7 years.

RESULTS: Mean operative time was 65.4 min in LASGBs and 94.2 min in LVBGs (p<0.05); mean hospital stay was 3.7 and 6.6 days, respectively (p<0.05).

Late complication rates were

36.7% in LASGBs vs 15.7% in LVBGs at 3 years (p<0.05),

46.9% vs 43.1% at 5 years (NS), and

55.1% vs 47.1% at 7 years (NS).

Late reoperation rates were

28.6% in LASGBs and 2.0% in LVBGs at 3 years (p<0.001),

38.8% and 2.0% at 5 years (p<0.001), and

46.9% and 7.8% at 7 years (p<0.001).

Excess weight loss in LASGBs was

41.8% at 3 years,

33.2% at 5 years, and

29.9% at 7 years;

excess weight loss in LVBGs was

60.9%,

57%, and

53.1%, respectively (p<0.05).

CONCLUSIONS:

This study demonstrates that

LVBG is significantly more effective than LASGB in terms of

late complications,

late reoperations, and

long-term results on weight loss.



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--
Dr. Rutledge
Email: DrR@clos.net
Private Cell Phone 702-215-9550
On the Web=> www.CLOS.Net

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Increased Need for Hospitalization after RNY Gastric Bypass

Unbiased Study shows RNY Gastric Bypass Increases Need for Hospitalization after gastric bypass surgery Primarily because of Complications
The rate of hospitalization in the year AFTER RNY was more than double the rate in the year preceding RNY (19% vs 8%, P<.001).

JAMA. 2005 Oct 19;294(15):1918-24.Click here to read Links

Comment in:
JAMA. 2005 Oct 19;294(15):1960-3.
JAMA. 2006 May 24;295(20):2355-6; author reply 2356.

Hospitalization before and after gastric bypass surgery.
Zingmond DS, McGory ML, Ko CY.

Division of General Internal Medicine and Health Services Research, Department of Medicine, The David Geffen School of Medicine at the University of California Los Angeles, Los Angeles 90095-1736, USA. dzingmond@mednet.ucla.edu

CONTEXT:

The use of Roux-en-Y gastric bypass (RYGB) has been reported to be effective in the treatment of obesity and its related comorbidities.

Need for Hospitalization after RYGB is less well understood.

OBJECTIVE:

To determine the rates and indications for inpatient hospital use before and after RYGB.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of Californians receiving RYGB in California hospitals from 1995 to 2004.

MAIN OUTCOME MEASURE: Hospitalization in the 1 to 3 years after RYGB.

RESULTS: In California from 1995 to 2004, 60,077 patients underwent RYGB-11,659 in 2004 alone.

The rate of hospitalization in the year following RYGB was more than double the rate in the year preceding RYGB (19.3% vs 7.9%, P<.001).

Furthermore, in the subset of patients (n = 24,678) with full 3-year follow-up,

a mean of 8.4% were admitted a year before RYGB

while 20.2% were readmitted in the year after RYGB,

18.4% in the second year after RYGB, and

14.9% in the third year after RYGB.

** The most common reasons for admission prior to RYGB were obesity-related problems (eg, osteoarthritis, lower extremity cellulitis), and elective operation (eg, hysterectomy),

** while the most common reasons for admission after RYGB were complications procedure related,

such as ventral hernia repair and gastric revision.

In multivariate logistic regression models predicting 1-year readmission after RYGB, increasing Charlson Comorbidity Index score, and hospitalization in the 3-year period prior to RYGB were significantly associated with readmission within a year.

CONCLUSIONS: Increases in hospital use after surgery appear to be related to RYGB. Payers, clinicians, and patients must consider the not-inconsequential rate of rehospitalization after this type of surgery.

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H. Pylori and Iron Deficiency Anemia
Reversal of Iron Deficiency Anemia after Helicobacter pylori Eradication in Patients with Asymptomatic Gastritis
New studies show that treatment of H. Pylori can treat certain forms of Iron Deficiency Anemia

Cure of H. pylori infection is associated with reversal of iron dependence and recovery from iron deficiency anemia.


Reversal of Iron Deficiency Anemia after Helicobacter pylori Eradication in Patients with Asymptomatic Gastritis
right arrow Bruno Annibale, MD; Massimo Marignani, MD; Bruno Monarca, MD; Giorgio Antonelli, MD; Adriana Marcheggiano, MD; Gina Martino, MD; Franco Mandelli, MD; Renzo Caprilli, MD; and Gianfranco Delle Fave, MD

2 November 1999 | Volume 131 Issue 9 | Pages 668-672

Background: Iron deficiency anemia is the most common form of anemia worldwide. Recent studies have suggested an association between Helicobacter pylori infection and iron deficiency.

Objective: To investigate the effects of eradicating H. pylori with combination antibiotic therapy on iron deficiency anemia in patients with H. pylori-associated gastritis.

Design: Case series.

Setting: University hospital.

Patients: 30 patients with a long history of iron deficiency anemia in whom H. pylori-associated gastritis was the only pathologic gastrointestinal finding detected.

Intervention: Eradication therapy with two antibiotics and discontinuation of iron replacement therapy.

Measurements: Complete blood count, ferritin levels, and gastroscopy with biopsy to evaluate H. pylori status.

Results: At 6 months, 75% of patients had recovered from anemia (P < 0.001), ferritin values increased from 5.7 ± 0.7 µg/L to 24.5 ± 5.2 µg/L (95% CI, 8.85 to 29.97). After 12 months, 91.7% of patients had recovered from anemia.
Conclusions: Cure of H. pylori infection is associated with reversal of iron dependence and recovery from iron deficiency anemia.

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Chocolate and Death from Heart Attack

Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold

1.
AFP: Chocolate 'cuts death rate' in heart attack survivors
Chocolate 'cuts death rate' in heart attack survivors. By Marlowe Hood (AFP) – Aug 13, 2009. PARIS — Heart attack survivors who eat chocolate two or more ...
www.google.com/.../ALeqM5gxKbyt-iymZ-PS8tgMMyi65kM4Tw - Similar
2.
Health Highlights: Aug. 13, 2009 - US News and World Report
Aug 13, 2009 ... Chocolate Helps Heart Attack Survivors Childhood Radiation Tied to ... that chocolate can help prevent death in heart attack survivors. ...
health.usnews.com/.../health-highlights-aug-13--2009.html - Cached - Similar
3.
Death by Chocolate? Not for Heart Attack Survivors
Aug 14, 2009 ... If you've survived a heart attack, you could dramatically cut your risk of dying from heart disease by eating chocolate two or more times ...
digg.com/.../Death_by_Chocolate_Not_for_Heart_Attack_Survivors - Cached - Similar
4.
Chocolate 'cuts death rate' in heart attack survivors | NowPublic ...
Aug 13, 2009 ... Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold compared to ...
www.nowpublic.com/.../chocolate-cuts-death-rate-heart-attack-survivors - Cached - Similar
5.
Study: Eating Chocolate Reduces Risk of Death in Heart Attack ...
Aug 13, 2009 ... Study: Eating Chocolate Reduces Risk of Death in Heart Attack Survivors, Here's one more reason to eat chocolate: A study finds that eating ...
www.foxnews.com/story/0,2933,539254,00.html - Cached - Similar
6.
Raw Story » Chocolate 'cuts death rate' in heart attack survivors
Aug 13, 2009 ... PARIS (AFP) – Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold ...
rawstory.com/.../chocolate-cuts-death-rate-in-heart-attack-survivors/ - Cached - Similar
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Chocolate cuts death risk in heart attack survivors - Health ...
Chocolate cuts death risk in heart attack survivors. ... even indulging in chocolate once a week can nearly halve the risk of death from heart problems. ...
timesofindia.indiatimes.com/.../Chocolate...death...heart-attack.../4896143.cms - Cached - Similar
8.
Chocolate cuts death rate after heart attack - Washington Times
Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold compared to those who never ...
www.washingtontimes.com/.../chocolate-found-to-cut-death-rate-after-heart-atta/?... - Cached - Similar
9.
Dark chocolate 'cuts death risk in heart attack survivors'
London, Aug 15 (ANI): A chocolate fix twice a week could be good for heart attacker sufferers, suggests a new study. The research, published in the Journal ...
www.thaindian.com/.../dark-chocolate-cuts-death-risk-in-heart-attack-survivors_100232765.html - Cached - Similar
10.
Study: Chocolate cuts risk of death in heart attack survivors - On ...
Aug 13, 2009 ... Chocolate lovers rejoice: A new study shows a substantial cut in the risk of death from heart disease for heart attack survivors who eat ...
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11.
News results for Chocolate and Death from Heart Attack
A Woman's Heart, Eating Chocolate May Reduce Risk of Cardiac Death ...‎ - 1 hour ago
What we are just now learning is that chocolate may also be beneficial to your heart health after a heart attack as well. A joint US-Swedish study recently ...



J Intern Med. 2009 Sep;266(3):248-57.Click here to read Links
Chocolate consumption and mortality following a first acute myocardial infarction: the Stockholm Heart Epidemiology Program.
Janszky I, Mukamal KJ, Ljung R, Ahnve S, Ahlbom A, Hallqvist J.

Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. imre.janszky@ki.se

OBJECTIVES: To assess the long-term effects of chocolate consumption amongst patients with established coronary heart disease.

DESIGN: In a population-based inception cohort study, we followed 1169 non-diabetic patients hospitalized with a confirmed first acute myocardial infarction (AMI) between 1992 and 1994 in Stockholm County, Sweden, as part of the Stockholm Heart Epidemiology Program. Participants self-reported usual chocolate consumption over the preceding 12 months with a standardized questionnaire distributed during hospitalization and underwent a health examination 3 months after discharge. Participants were followed for hospitalizations and mortality with national registries for 8 years.

RESULTS: Chocolate consumption had a strong inverse association with cardiac mortality. When compared with those never eating chocolate, the multivariable-adjusted hazard ratios were 0.73 (95% confidence interval, 0.41-1.31), 0.56 (0.32-0.99) and 0.34 (0.17-0.70) for those consuming chocolate less than once per month, up to once per week and twice or more per week respectively. Chocolate consumption generally had an inverse but weak association with total mortality and nonfatal outcomes. In contrast, intake of other sweets was not associated with cardiac or total mortality.

CONCLUSIONS: Chocolate consumption was associated with lower cardiac mortality in a dose dependent manner in patients free of diabetes surviving their first AMI. Although our findings support increasing evidence that chocolate is a rich source of beneficial bioactive compounds, confirmation of this strong inverse relationship from other observational studies or large-scale, long-term, controlled randomized trials is needed.