Sleeve gastrectomy (SG), which, thus far, is showing good resolution of comorbidities and good weight loss, shows increasing popularity among bariatric surgeons. The aim of this study was to evaluate clinical outcome and the gastric emptying of solid foods, 24 months after SG.

 

Methods

Fourteen morbidly obese patients, four males and ten females, median age 41 years (range 29–65), median body mass index (BMI) 49.46 kg/m2 (range 41.14–55.63), who underwent SG for weight loss, were studied prospectively. Nine patients underwent gastric emptying studies, using radioisotopic technique before, 6 months and 24 months after the operation. The remaining five patients underwent gastric emptying studies, 6 months and 24 months after the operation.
 
Results
A significant reduction in patients’ weight and BMI was evident at 6, 12 and 24 months postoperatively. In the nine patients who underwent gastric emptying studies pre-, 6 and 24 months postoperatively, the T-lag phase duration significantly decreased, following the SG, from 17.30 (range 15.50–20.90) min, to 12.50 (range 9.20–18.00) min at 6 months and 12.16 (range 10.90–20.00) min at 24 months postoperatively (P < 0.05). The gastric emptying half time (T1/2) accelerated significantly postoperatively from 86.50 (range 77.50–104.60) min, to 62.50 (range 46.30–80.00) min at 6 months and 60.80 (range 54.80–100.00) min at 24 months after SG (P < 0.05). The percentage of gastric emptying (%GE) increased significantly postoperatively, from 52 (range 43–58) % to 72 (range 57–97) % at 6 months and 74 (range 45–82) % at 24 months, following SG (P < 0.05). No differences in gastric emptying were observed, when values at 24 months were compared to those at 6 months postoperatively. When the whole group of 14 patients was studied, there were also no significant changes in T-lag, T1/2 and %GE between 6 and 24 months postoperatively.
 
Conslusions
Our study indicates the constant effect of SG in the acceleration of gastric emptying of solids, which occurs faster, not only in short but also in long-term postoperatively. Such effects on gastric motility, in combination with the reported alterations in gut hormones, may explain how this ‘food limiting’ operation results in weight loss. 
 
Publication date: 2008/10/1 - Journal: Obesity surgery - Publisher: Springer-Verlag Description 
Authors: John Melissas, Markos Daskalakis, Sophia Koukouraki, Ioannis Askoxylakis, Maria Metaxari, Efstathios Dimitriadis, Maria Stathaki, John A Papadakis
 
 
 
 
 
 
 

Diet and surgically-induced weight loss have been shown to lead to alterations in motor and sensory function of the stomach. We investigated the clinical outcome and gastric emptying of solid foods in morbidly obese (MO) patients following sleeve gastrectomy (SG).

 
Methods
We studied 23 MO patients [(7 males, 16 females), mean age 38.9 ±11.0 years (range 20–64 years), mean weight 135.1 ±19.0 kg (range 97–167 kg), mean BMI 47.2 ±4.8 kg/m2 (range 39.6–56.0 kg/m2)] who each underwent a sleeve gastrectomy (SG) for weight reduction. At the monthly follow-up visits, variations in weight and BMI changes, postoperative meal size and frequency, and presence of gastrointestinal symptoms were recorded. 11 patients underwent scintigraphic measurement of the gastric emptying of a solid meal pre- and 6 months postoperatively.
 
Results
A significant reduction in patients’ weight was evidenced at 6 and 12 months postoperatively [98.6 ±11.8 kg and 87.0 ±10.7 kg respectively (P=0.001)]. BMI decreased to 35.2 ±4.3 kg/m2 at 6 months and to 31.1 ±4.5 kg/m2 at 12 months, respectively (P=0.001). Although meal size was drastically reduced, meal frequency increased postoperatively in 12 patients (52.2%). Only 5 patients (21.8%) reported occasional vomiting after meals following SG. The gastric emptying half-time (T1/2) accelerated (47.6 ±23.2 vs. 94.3 ±15.4, P<0.01) and the T-lag phase duration decreased (9.5 ±2 min vs. 19.2 ±2 min, P<0.05) postoperatively. The percentage of the meal emptied from the stomach 90 min after consumption increased significantly after SG (75.4 ±14.9% vs. 49.2 ±8.7%, P<0.01).
 
Conclusions
This study indicates that following SG, the stomach empties its contents rapidly into the small intestine and symptoms of vomiting after eating (characteristic of restrictive procedures) are either absent or very mild. Therefore, the term ‘restrictive’ is possibly ill-advised for this new bariatric operation. It remains for other mechanisms of energy intake reduction, such as intestinal distension and satiety signals through gut hormones to be investigated, to comprehensively explain precisely how this ‘food limiting’ procedure results in weight loss.
 
 
Publication date: 2007/1/1 - Journal: Obesity surgery - Publisher: Springer-Verlag Description 
Authors: John Melissas, Sofia Koukouraki, John Askoxylakis, Maria Stathaki, Markos Daskalakis, Kostas Perisinakis, Nikos Karkavitsas
 
 
 
 
 
 
 

Intragastric balloon placement in association with diet for weight reduction is steadily gaining popularity. However, long-term follow-up studies on the effect of this method in maintaining weight loss are lacking. This study evaluated the long-term outcome following balloon removal in morbidly obese patients who had selected this method for weight loss.

Methods

140 morbidly obese patients who refused bariatric surgery because of fear of complications and mortality, underwent intragastric balloon placement and were followed over a 6- to 30-month period (mean 18.3 months) after balloon extraction. The 34 males and 106 females, with median age 38 years (range 16-62), median weight 122 kg (range 85-203), median BMI 42.3 kg/m2 (range 35-61.3) and median excess weight (EW) 59 kg (range 29-132), received a Bioenterics Intragastric Balloon (BIB). Excess weight loss (EWL) ≥25% when the BIB was removed was considered a success. Weight fluctuations and any further interventional therapy requested by the patients after balloon removal were recorded. Results: 100 patients (71.4%) lost ≥25% of their EW on balloon extraction and were categorized as successes, while 40 patients (28.6%) did not achieve that weight loss and were categorized as failures of the method. During the follow-up period, 44 of the originally successful patients (31.4%) regained weight and were categorized as recurrences, while the remaining 56 patients (40%) maintained their EWL of ≥25% and were considered long-term successes. During follow-up, 45 patients (32.1%) requested and underwent bariatric surgery for their morbid obesity (21 Adjustable Gastric Band, 11 Laparoscopic Sleeve Gastrectomy, 13 Laparoscopic Gastric Bypass). Of these, 13 (32.5%) were from the group of 40 patients categorized as failures on BIB removal, 28 (63.6%) were from the group of 44 patients whose obesity recurred, and 4 (7.1%) were from the 56 patents who although they maintained successful weight loss requested further weight reduction. 
 
Conclusions
The BIB served as a first step and a smooth introduction to bariatric surgery for morbidly obese patients who initially refused surgical intervention. The incidence of surgical intervention was double in patients who initially experienced the benefits of weight loss and then had obesity recurrence, compared with patients in whom the method failed. Indeed, a significant number of patients were assisted in their efforts to lose and maintain an acceptable weight loss over a 6- to 30-month follow-up period.
 
Publication date: 2006/7/1 - Journal: Obesity surgery - Publisher: Springer-Verlag Description 
Authors: John Melissas, John Mouzas, Dimetrios Filis, Markos Daskalakis, Erminia Matrella, John A Papadakis, Nikos Sevrisarianos, Demetris Charalambides
 
 
 
 
 
 
 

Guidelines for the learning period of sentinel lymph node biopsy in breast cancer do not address important details such as the false negative rate way of calculation and the number of patients with positive axilla that should be included among the cases of this period. The aim of this study was to identify refinement points which should be included in the guidelines..

 

Methods

We studied 138 breast cancer cases of the sentinel lymph node biopsy learning period of three surgeons. The sentinel node was identified using isosulfan blue or technetium sulfur colloid or both. All patients underwent complementary axillary dissection.
 
Results
All three surgeons (A, B, C) fulfilled the guidelines' false negative rate criteria of 5, 0 and 5%, respectively, after 20 cases. However, only six, 10 and 10 cases with positive axilla, respectively, were included and the false negative rates using only these cases were 17, 0 and 10%, respectively.
 
Conslusions
Current guidelines may lead surgeons to inappropriate conclusions about their ability to perform sentinel lymph node biopsy with an acceptable false negative rate. The learning period should include as many cases with positive axilla as possible and the false negative rate should be calculated only on those patients.
 
Publication date: 2005/5/1 - Journal: European Journal of Surgical Oncology (EJSO) - Publisher: WB Saunders
Authors: EE Sanidas, M Daskalakis, N Sbyrakis, DD Tsiftsis
 
 
 
 
 
 
 
Χρησιμοποιούμε cookies στον ιστότοπό μας. Ορισμένα από αυτά είναι απαραίτητα για τη λειτουργία του ιστότοπου, ενώ άλλα μας βοηθούν να βελτιώσουμε αυτόν τον ιστότοπο και την εμπειρία χρήστη (cookies παρακολούθησης). Μπορείτε να αποφασίσετε μόνοι σας εάν θέλετε να επιτρέπετε τα cookies ή όχι. Λάβετε υπόψη ότι εάν τα απορρίψετε, ενδέχεται να μην μπορείτε να χρησιμοποιήσετε όλες τις λειτουργίες του ιστότοπου.