Minimally Invasive Bariatric Surgery (eBook)

Stacy Brethauer, Phillip R. Schauer, Bruce D. Schirmer (Herausgeber)

eBook Download: PDF

2008 | 2007
XXII, 523 Seiten
Springer New York (Verlag)
978-0-387-68062-0 (ISBN)

Infos

PREFACE

Over the last decade, bariatric surgeons have witnessed more dramatic advances in the field of bariatric surgery than in the previous 50 years of this relatively young discipline. These changes have certainly been fueled by the great obesity epidemic beginning in the 1970's which created the demand for effective treatment of severe obesity and its co-morbidities. The gradual development and standardization of safer, more effective, and durable operations such as Roux-en Y gastric bypass (RYGB), biliopancreatic diversion, duodenal switch, and adjustable gastric banding account for the first wave of advances over the last decade. More recently, the advent of minimally invasive surgery in the mid 1990's accounts for the second wave of major advances.

 

Fifteen years ago, fewer than 15,000 bariatric procedures (mostly vertical banded gastroplasty) were performed each year in the U.S. and all were performed with a laparotomy requiring nearly a week of hospitalization and 6 weeks of convalescence. Mortality rates exceeding 2 percent and major morbidity exceeding 25% was the norm. It later became apparent that the laparotomy itself accounted for much of the morbidity of bariatric surgery contributing to major impairment in postoperative cardiopulmonary function leading to atelectasis, pneumonia, respiratory failure, heart failure, and lengthy stays in the intensive care unit for a significant subset of patients. Furthermore, wound complications including infections, seromas, hernias and dehisences were the norm rather than the exception. Hernias were so common (20-25%) that they were often considered the second stage of a bariatric procedure.

 

Today, over 200,000 bariatric procedures are performed each year in the U.S. and nearly twice that figure worldwide. Nearly all gastric banding procedures, an estimated 75% of RYGB procedures, and even some BPD procedures are performed laparoscopically indicating that the laparoscopic approach has been widely adopted in bariatric surgery. The dramatic reduction in postoperative pain, hospital stay to 1-3 days, recovery to 2-3 weeks, incidence of intensive care utilization to < 5% along with a great reduction in cardiopulmonary complications and wound complications can be attributed to the laparoscoic approach. Operative mortality of less than 1% is now common and perhaps also attributable to laparoscopic surgery. Indeed bariatric surgery has become safer and more desirable because of laparoscopic surgery.

 

This textbook, Minimally Invasive Bariatric Surgery, is intended to provide the reader with a comprehensive overview of the current status of bariatric surgery emphasizing the now dominant role of laparoscopic techniques. It is our intention to address issues of interest to not only seasoned and novice bariatric surgeons but all health care provides who participate in the care of the bariatric patient. Specifically, we expect surgical residents, fellows, allied health, and bariatric physicians to benefit from this book. At the onset of this book, we invited contributing authors who we considered the most authoritative, coming up with a 'Who's Who' list of bariatric surgeons. The reader will note among the authors a high degree of clinical expertise, international diversity, as well as diversity of thought. We have even included a chapter on the role of open bariatric surgery to balance the enthusiasm of the editors to minimally invasive surgery. Furthermore, we're thankful for our good fortune in recruiting authors who have been on the forefront in developing and teaching specific procedures. Although not intended to be an atlas of bariatric surgery, this text does provide detailed illustrations and descriptions of all the common procedures with technical pearls from the surgeons who introduced them to the world.

 

The benefits of laparoscopic surgery, however, must be balanced with the significant training challenges posed by laparoscopic bariatric surgery. Special emphasis on learning curves and training requirements are found through out this text. A chapter on training and credentialing is included to update the reader on current guidelines.

 

To further enlighten the reader, we also have included chapters on special issues and controversial subjects including laparoscopic instruments and visualization, bariatric equipment for the ward and clinic, medical treatment of obesity, hand-assisted surgery, hernia management, diabetes surgery, perioperative care, pregnancy and gynecologic issues, and plastic surgery after weight loss. Chapter 24, 'Risk-Benefit Analysis of Laparoscopic Bariatric Procedures,' is particularly useful in that it compares head-to-head the risks and benefits of all the major operations. Finally, we do incorporate chapters that focus on new and futuristic operations such as sleeve gastrectomy, gastric pacing, and endoluminal /natural orifice surgery - perhaps the next wave of minimally invasive surgery.

 

In the wake of the laparoscopic revolution of the 1990's, minimally invasive approaches to nearly every abdominal procedure and many thoracic procedures have been devised; however, in reality, only a few common procedures are now performed with a laparoscopic approach as the standard (ie. >50%). Laparoscopic cholecystectomy, Nissen fundoplication, and bariatric procedures represent the major triumphs thus far of the laparoscopic revolution. Perhaps, bariatric operations represent the best application of minimally invasive procedures because avoidance of an extensive laparotomy in the high-risk bariatric population provides the greatest relative benefit. We hope that you encounter as much enjoyment reading Minimally Invasive Bariatric Surgery as we have had writing it! Now, on to the next revolution in bariatric surgery!

Phil Schauer, MD

Bruce Schirmer, MD

Stacy Brethauer, MD

 

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"e;Minimally Invasive Bariatric Surgery"e; covers the full spectrum of laparoscopic weight loss surgery and the pathophysiology of obesity. The chapter authors, all currently operating experts in the field, cover the essentials of establishing a bariatric surgery program, including equipment needs, guidelines for training, and patient selection. The operative chapters discuss in full detail the surgical techniques and outcomes, including laparoscopic VGB, laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y, and laparoscopic malabsorption procedures. The text also tackles post-operative issues, such as complications, reoperation, plastic surgery after weight loss, nutritional issues, and pregnancy following obesity surgery. The text is graphically enhanced with over 175 full-color and 265 black and white images: surgical photos, anatomical drawings, operative technique illustrations and management algorithms. "e;Minimally Invasive Bariatric Surgery"e; enables clinicians to provide their patients with a viable solution to chronic obesity.

Inhalt

Preface 6
Acknowledgments 8
Contents 9
Contributors 14
1 Pathophysiology of Obesity Comorbidity: The Effects of Chronically Increased Intraabdominal Pressure 20
2 The Medical Management of Obesity 26
3 Evolution of Bariatric Minimally Invasive Surgery 35
4 Essential Characteristics of the Successful Bariatric Surgeon: Skills, Knowledge, Advocacy 43
5 Bariatric Surgery Program Essentials 49
6 Essential Bariatric Equipment: Making Your Facility More Accommodating to Bariatric Surgical Patients 54
7 Bariatric Surgery Training 67
8 Patient Selection, Preoperative Assessment, and Preparation 72
9 The Evolving Role of the Psychologist 79
10 Operating Room Positioning, Equipment, and Instrumentation for Laparoscopic Bariatric Surgery 101
11 Access to the Peritoneal Cavity 118
12 Comparison of Open Versus Laparoscopic Obesity Surgery 125
13 Anesthesia for Bariatric Surgery: What a Surgeon Needs to Know 130
14 Pneumoperitoneum in the Obese: Practical Concerns 138
15 Postoperative Assessment, Documentation, and Follow-Up of Bariatric Roux-en-Y Surgical Patients 145
16 Bariatric Data Management 152
17 The Current Role of Open Bariatric Surgery 158
18 Technical Pearls of Laparoscopic Bariatric Surgery 166
19.1 Laparoscopic Vertical Banded Gastroplasty 173
19.2 Laparoscopic Sleeve Gastrectomy 181
20.1 Laparoscopic Adjustable Gastric Banding: Technique 187
20.2 Laparoscopic Adjustable Gastric Banding: Outcomes 197
20.3 Laparoscopic Adjustable Gastric Banding: Postoperative Management and Nutritional Evaluation 205
20.4 Laparoscopic Adjustable Gastric Banding: Complications 212
20.5 Laparoscopic Adjustable Gastric Banding: Revisional Surgery 220
20.6 Laparoscopic Adjustable Gastric Banding: Controversies 238
21.1 Circular Stapler Technique for Gastroenterostomy 244
21.2 Circular Stapled Transabdominal Technique 254
21.3 Laparoscopic Roux-en-Y Gastric Bypass: Hand-Sewn Gastrojejunostomy Technique 257
21.4 Linear Stapled Technique for Gastrojejunal Anastomosis 267
21.5 Laparoscopic Roux-en-Y Gastric Bypass: Outcomes 277
21.6 Laparoscopic Roux-en-Y Gastric Bypass:Postoperative Management and Nutritional Evaluation 287
21.7 Laparoscopic Roux-en-Y Gastric Bypass: Complications 296
21.8 Gastric Bypass as a Revisional Procedure 305
21.9 Laparoscopic Roux-en-Y Gastric Bypass: Controversies 315
22.1 Laparoscopic Biliopancreatic Diversion with Duodenal Switch 321
22.2 Laparoscopic Malabsorption Procedures: The Technique of Biliopancreatic Diversion 331
22.3 Laparoscopic Malabsorption Procedures: Outcomes 339
22.4 Laparoscopic Malabsorption Procedures: Postoperative Management and Nutritional Evaluation 343
22. 5 Laparoscopic Malabsorption Procedures: Complications 348
22.6 Laparoscopic Malabsorption Procedures: Controversies 357
23 Hand-Assisted Laparoscopic Bariatric Surgery 365
24 Risk–Benefit Analysis of Laparoscopic Bariatric Procedures 370
25.1 Alternative Minimally Invasive Options: Gastric Pacing 380
25.2 The BioEnterics Intragastric Balloon for the Nonsurgical Treatment of Obesity and Morbid Obesity 389
25.3 The Emerging Field of Endoluminal and Transgastric Bariatric Surgery 395
26 Venous Thrombosis and Pulmonary Embolism 406
27 Role of Flexible Endoscopy in the Practice of Bariatric Surgery 411
28 Bariatric Surgery in Adolescents 416
29 Bariatric Surgery in the Elderly 425
30 The High-Risk Bariatric Patient 429
31 Gastroesophageal Reflux Disease in the Bariatric Surgery Patient 434
32 Gallbladder Disease in the Bariatric Surgery Patient 440
33 Diabetes in the Bariatric Surgery Patient 444
34 Cardiovascular Disease and Hypertension in the Bariatric Surgery Patient 455
35 Sleep Apnea in the Bariatric Surgery Patient 461
36 Ventral Hernias in the Bariatric Patient 473
37 Plastic Surgery Following Weight Loss 478
38 The Female Patient: Pregnancy and Gynecologic Issues in the Bariatric Surgery Patient 488
39 Medicolegal Issues: The Pitfalls and Pratfalls of the Bariatric Surgery Practice 494
Index 504

Produkt-Details

• Erscheint lt. Verlag: 11.9.2008
• Zusatzinfo: XXII, 523 p.
• Verlagsort: New York
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Anästhesie
• Themenwelt: Medizinische Fachgebiete ► Chirurgie ► Viszeralchirurgie
• Schlagworte: abdominal surgery • Bariatric Surgery • Endoscopy • Gastric Banding • Laparoscopic • Obesity • Surgery
• ISBN-10: 0-387-68062-4 / 0387680624
• ISBN-13: 978-0-387-68062-0 / 9780387680620