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BLEEDING FOLLOWING BARIATRIC SURGERY (TYPES & MANAGEMENT MODALITIES)

Authors: Falih Mohsen Al-Gazgooz --- Abdulkareem Jabbar Ghadban Al-Ebadi
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2018 Volume: 24 Issue: 2 Pages: 49-55
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract Bleeding is a serious complication following bariatric procedures such as Minigastric bypass (MGB), Roux-En-Y Gastric Bypass (RYGB) Surgery, and Sleeve Gastrectomy (SG). Post bariatric bleeding is either acute or chronic. Although this complication is declined now, but still it is important to know because if it is not managed urgently it will lead to serious results. The source of bleeding may be from the staple lines, unexpected injury to the spleen, or to one of the blood vessels around the surgical field. The other source of bleeding may be internal through the GIT and it is presented as hematemesis or melena. Gastrointestinal bleeding in patients underwent bariatric surgery may occur in the esophagus, gastric pouch, new sleeved stomach, the Roux limb just distal to the anastomosis, the remaining of the small intestine. The site of bleeding can be determined and treated mostly by endoscopy but in certain cases may require re-laparoscopy. The aim of this study is to analyze the incidence, types and management of this bleeding.This is a prospective study which has been done in Al-Sadr Teaching Hospital, Basrah, Iraq, from June 2015 to June 2017. The study included 540 case who were subjected to SG, RYGB, MGB and they were analyzed regarding; time of occurrence, postoperative bleeding, types whether intra-peritoneal or intra-luminal and type of approaches for treating this bleeding. In our study we don’t over sewn the staple line and didn't use any buttressing material or synthetic coagulation powder. The total number of patients developed post-operative bleeding were 18 cases out of 540, 12 after sleeve gastrectomy, 3 after mini gastric bypass and 3 after Roux-En-Y. Regarding sleeve gastrectomy; two patients of the required re-laparoscopy and evacuation of hematoma with treating site of bleeding by clipping or suturing according to the condition, three patients required aspiration under ultrasound guide, while the remaining 7 cases were kept only under conservative measures. The 3 patient of the MGB were managed conservatively and the 3 cases of Roux-En-Y were managed either conservatively in 2 cases or by endoscopic intervention in one case. In conclusion, we advise the surgeons to use reinforcement of staple line to decrease incidence of post-operative bleeding.


Article
Impact of Weight Loss Achieved Through Gastric Sleeve Surgery with Circulating Level of Ghrelin Hormone in Obese Subjects

Authors: Zainab A. Razak A. Ghani --- Ramiz Sami Mukhtar --- MuayadAbassFadhel --- Kisma M. Turki*
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 2 Pages: 216-221
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACK GROUND: The epidemic of obesity is a major health problem in the developed world with a great influence on morbidity and mortality. OBJECTIVE: To evaluate serum ghrelin levels achieved through LSG and on insulin resistance and the serial changes of insulin concentration in obese patients following gastric sleeve.SUBJECTS AND METHODS:Twenty four patients underwent LSG with 25 controls were selected. Body mass index (BMI), waist circumference (WC), lipid profile, fasting blood sugar (FBS), glycated hemoglobin (HbA1c), fasting insulin, QUICKI and ghrelin hormone concentrations were measured for controls and patients prior LSG, then one month and three months post-surgery. RESULTS:A significant decline was noticed in BMI, WC, TC, TG, LDL-cholesterol, fasting insulin, and ghrelin, with significant increase in QUICKI in patients undergone LSG with significant differences in all studied parameters between patients and controls. A negative correlation was noticed between ghrelin and BMI in patients before sleeve gastrectomy.CONCLUSION:Ghrelin is a hormone closely linked with obesity taking into account the marked loss in appetite in the period after laparoscopic sleeve gastrectomy.


Article
6.CHOLELITHIASIS FOLLOWING BARIATRIC SURGERY: A NEW APPROACH TO DEAL WITH

Authors: Sajid H.A. Al-Helfy ساجد حميد الحلفي --- Qasim S. Almayah قاسم شرهان المياحي --- Risala H. Allami
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2017 Volume: 15 Issue: 2 Pages: 143-150
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: Obesity and rapid weight loss induced by weight-reducing surgery are well recognized as a risk factor for the development of gallbladder stones. There is no standard policy whether to perform prophylactic cholecystectomy at the time of the bariatric operation or to give postoperative treatment to decrease the risk.Objective: To evaluate the incidence and risk factors of gallstone formation post-bariatric surgery. The results may help to decide how to deal with and follow up patients with post-bariatric surgery.Methods: A total of 120 patients who underwent weight-reducing operations were recruited for this study. Several factors expected to influence gallstone formation were recorded such as body mass index and excessive weight loss. Study population was followed up for 12 months postoperatively. Ultrasonography examination was performed for those who developed symptoms suggesting gallstone formation.Results: Twenty-six (21.7%) patients were found to develop gallstones. Of the studied risk factors, the percentage of excess weight loss, family history and carrying allele A of the variant rs670 were significant for predicting development of gallstone post-bariatric procedures. Conclusion: Based on the results of this study, it is reasonable to put an index for the risk of developing gallstone following bariatric surgery, and according to this index, the surgeon could decide whether to perform concomitant cholecystectomy along with the bariatric procedure or do not.Keywords: Bariatric surgery, cholelithiasis, single nucleotide polymorphismCitation: Sajid H.A. Al-Helfy, Qasim S. Almayah, Risala H. Allami. Cholelithiasis following bariatric surgery: a new approach to deal with. Iraqi JMS. 2017; Vol. 15(2): 143-150. doi: 10.22578/IJMS.15.2.6


Article
Impact of weight loss achieved through gastric sleeve surgery with circulating level of ghrelin hormone in obese Iraqi subjects.
أثر انقاص وزن الجسم بواسطه تكميم المعدة بالناظور على هرمون الجريلين عند المرضى العراقيين المصابين بالسمنة المرضية

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Abstract

Back ground: The epidemic of obesity is a major health problem in the developed world with a great influence on morbidity and mortality. The aim of study: to evaluate serum ghrelin levels achieved through LSG and on insulin resistance and the serial changes of insulin concentration in obese patients following gastric sleeve.Patients and methods: twenty four patients underwent LSG with 25 controls were selected. Body mass index (BMI), waist circumference (WC), lipid profile, fasting blood sugar (FBS), glycated hemoglobin (HbA1c), fasting insulin, QUICKI and ghrelin hormone concentrations were measured for controls and patients prior LSG, then one month and three months post-surgery. Results: A significant decline was noticed in BMI, WC, TC, TG, LDL-cholesterol, fasting insulin, and ghrelin, with significant increase in QUICKI in patients undergone LSG with significant differences in all studied parameters between patients and controls. A negative correlation was noticed between ghrelin and BMI in patients before sleeve gastrectomy.Conclusion: Ghrelin is a hormone closely linked with obesity taking into account the marked loss in appetite in the period after laparoscopic sleeve gastrectomy. Key word: obesity, bariatric surgery, ghrelin.

المقدمة: تعد السمنة من الامراض المنتشرة بشكل واسع في انحاء العالم المعاصر والمسببة لمشاكل صحية جمة كان لها الاثر الكبير في ارتفاع معدلات الوفيات وباقي الاعراض الناجمة عن علل صحية خطرة. هدف الدراسة: لتقييم مستويات هرمون الجريلين في مصل الدم وعلى مقاومة الانسولين والتغييرات المتسلسلة في تركيز الأنسولين بعد عملية تكميم المعدة بالناظورعند المرضى الذين يعانون من السمنة المفرطة. المرضى وطريقة العمل: تضمنت الدراسة أربعة وعشرين مريضا ممن اجروا عملية تكميم المعدة بالناظور مع 25 من الاصحاء كمجموعة ضابطة.تم قياس كلا من مؤشر كتلة الجسم ، محيط الخصر، النسبة المئوية لدهون الجسم مع نسبة السكر في الدم ، الهيموجلوبين السكري , الدهون الثلاثية والكوليسترول ,الانسولين وهرمون الجريلين عند المرضى والمجموعة الضابطة قبل اجراء العملية ومن ثم بعد شهر واحد و ثلاثة أشهر من الجراحة.النتائج: لوحظ انخفاض كبير في مؤشر كتلة الجسم، محيط الخصر، النسبة المئوية لدهون الجسم, الكولسيترول، الدهون الثلاثية ، الانسولين، وهرمون جريلين عند المرضى الذين خضعوا للعملية. وقد لوحظ وجود علاقة سلبية بين هرمون الجريلين ومؤشر كتلة الجسم لدى المرضى قبل تكميم المعدة.الاستنتاج: الغريلين هو هرمون يرتبط ارتباطا وثيقا مع السمنة مع الأخذ بعين الاعتبار فقدان ملحوظ في الشهية في فترة ما بعد تكميم المعدة بالمنظار.مفتاح الكلمات: السمنة, تكميم المعدة بالناظور, هرمون الجريلين

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