Obesity: Fried M

Fried M, Hainer V, Basdevant A, Buchwald H, Dietel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. · Klinické centrum pro minimálne invazivní a bariatrickou chirurgii ISCARE a 1. lékarská fakulta Univerzity Karlovy, Praha, Cesko. · Vnitr Lek. · Pubmed #18630623 No free full text.

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Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K, Anonymous00354. · Clinical Center for Minimally Invasive and Bariatric Surgery, Prague, Czech Republic. · Obes Surg. · Pubmed #17476884 No free full text.

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Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. · Clinical Center for Minimally Invasive and Bariatric Surgery, 1st Medical Faculty, Charles University, Prague, Czech Republic. · Int J Obes (Lond). · Pubmed #17325689 No free full text.

Abstract: In 2005, for the first time in European history, an extraordinary Expert panel named 'The BSCG' (Bariatric Scientific Collaborative Group), was appointed through joint effort of the major European Scientific Societies which are active in the field of obesity management. Societies that constituted this panel were: IFSO - International Federation for the Surgery of Obesity, IFSO-EC - International Federation for the Surgery of Obesity - European Chapter, EASO - European Association for Study of Obesity, ECOG - European Childhood Obesity Group, together with the IOTF (International Obesity Task Force) which was represented during the completion process by its representative. The BSCG was composed not only of the top officers representing the respective Scientific Societies (four acting presidents, two past presidents, one honorary president, two executive directors), but was balanced with the presence of many other key opinion leaders in the field of obesity. The BSCG composition allowed the coverage of key disciplines in comprehensive obesity management, as well as reflecting European geographical and ethnic diversity. This joint BSCG expert panel convened several meetings which were entirely focused on guidelines creation, during the past two years. There was a specific effort to develop clinical guidelines, which will reflect current knowledge, expertise and evidence based data on morbid obesity treatment.

Fried M. · Klinické centrum ISCARE-Lighthouse, Praha a 1. lékarská fakulta UK Praha. · Vnitr Lek. · Pubmed #18630628 No free full text.

Abstract: Overweight and obesity are connected with increased risk of obesity related co-morbidities, such as T2DM, hypertension, cardiovascular diseases, dyslipidaemia and others, as well as in higher risk of some malignant diseases. In obese population there is 2.5-3.3 fold increased risk of renal cell carcinoma in comparison with non-obese population of similar age. It has been proven in many studies that for severely obese patients there is no other more effective treatment of their obesity and co-morbidities than bariatric. Bariatric surgery decreases mortality risks, treat existing, obesity related co-morbidities, and can act as prevention of onset of new obesity related co-morbidities. Moreover at the end bariatric surgery lowers economic burden of health care systems. Nowadays, bariatric surgery is considered to be standard treatment option and pathway in complex management of morbidly obese patients.

Levy P, Fried M, Santini F, Finer N. · LEGOS, University of Paris Dauphine, Paris, France. · Obes Surg. · Pubmed #18074502 No free full text.

Abstract: BACKGROUND: Epidemiological evidence confirms that risk of developing type 2 diabetes is related to weight gain. Weight reduction is beneficial as relative risk is reduced to 0.13 for weight loss >20 kg. This raises the question of effectiveness of bariatric surgery on 1) weight loss and 2) diabetes-related outcomes in morbidly obese patients. METHODS: We reviewed the literature using Medline. Only 2 meta-analyses reporting on both outcomes were included, as well as 50 systematic reviews or primary studies. RESULTS: Meta-analyses mainly based on case series data as well as controlled studies confirm that bariatric surgery is highly effective in obtaining weight reduction in morbidly obese patients up to 60% of the excess weight, along with resolution of preoperative diabetes in more than 75% of cases. Among bariatric surgery techniques, malabsorptive procedures (biliopancreatic diversion and gastric bypass) appear to be more effective on both outcomes than restrictive procedures (gastroplasty and gastric banding). CONCLUSION: Even if more studies are needed to confirm current evidence, bariatric surgery is effective for controlling diabetes. It appears as an efficient strategy from economic modeling due to savings from reduction in diabetes-related costs.

Svacina S, Fried M, Machková N. · III. interní klinika 1. LF UK a VFN, Praha. · Cas Lek Cesk. · Pubmed #17874729 No free full text.

Abstract: Gastric balloon application is not an effective method for obesity treatment. It is a high risk treatment with many possible complications. To detect balloon leak methylene blue is used. The only indication for the use of balloon is preparing patients with morbid obesity for gastric banding using balloon for 4-6 months. This initial balloon-induced weight loss does not treat obesity definitely, but is used as a preoperative preparation for surgical obesity treatment.

Fried M, Kasalicky M, Melechovsky D, Kormanova K. · 1st Surgical Department, Charles University General Faculty Teaching Hospital, Prague, Czech Republic. · Obes Surg. · Pubmed #12082895 No free full text.

Abstract: BACKGROUND: The purpose of this study is to review the current status of non-adjustable gastric banding (NGB) and to determine whether this operation is still acceptable in the management of morbid obesity, especially when compared with the adjustable GB (AGB) in long-term results. MATERIALS AND METHODS: A literature search was conducted of data published on NGB and AGB in Obesity Surgery in the past 12 months or available from other sources, with records of early and late band-related complications, reoperation rate and weight loss in groups reporting > or = 100 patients with minimum 3-year postoperative follow-up. RESULTS: 1,812 NGB and 1,968 AGB patients were included. Mean BMI was 42.4 in NGB vs 44.0 in AGB. No statistical difference occurred in the early complication rate (1.4% in NGB vs 1.6% in AGB). A statistical difference was noted in long-term complication rate, (1.9% in NGB vs 6.7% in AGB), and in reoperation rate (3.4% vs 7.2%). There was no difference in excess weight loss at 48 months following both operations (54.2% vs 53.0%). CONCLUSION: A significant difference in favor of NGB occurred in the long-term reoperation rate. No other differences were identified, other than in band material. NGB is a softer material and therefore, according to computerized images, has greater flexibility in copying gastric peristaltic waves, which may result in less irritation and more physiological behavior by this band.

Fox M, Stutz B, Menne D, Fried M, Schwizer W, Thumshirn M. · Department of Gastroenterology, St. Thomas' Hospital, London, UK. · Dig Dis Sci. · Pubmed #16133954 No free full text.

Abstract: Continence problems during treatment with orlistat (a lipase inhibitor) are caused when susceptible patients are exposed to increased volumes of loose, fatty stool. Aim: To investigate the dose-response effects of loperamide on continence and anorectal function in subjects susceptible to continence problems on orlistat. METHOD: Ten obese subjects enterred a randomized controlled, double-blind study of loperamide at placebo, 2, 4, and 6 mg/day in a factorial design. Continence problems during orlistat treatment were self-assessed by patient diary. Anorectal function and continence were assessed by barostat, manometry, and retention testing. RESULTS: Loperamide increased stool consistency with dose (p = 0.07) and this effect reduced continence problems during orlistat treatment (p < 0.05). A bell-shaped dose-response relationship was present with anal sphincter function (p < 0.01) and anorectal sensitivity (p < 0.01). CONCLUSION: Loperamide has beneficial effects on stool consistency and continence in obese subjects taking orlistat. The effect on stool consistency appeared more important than effects on anorectal function.

Fox M, Schwizer W, Menne D, Stutz B, Fried M, Thumshirn M. · Department of Gastroenterology and Hepatology, University Hospital of Zürich, Zürich, Switzerland. · Dis Colon Rectum. · Pubmed #15657667 No free full text.

Abstract: PURPOSE: The intermittent loss of oil or stool ("spotting") is an adverse effect that occurs in patients taking orlistat; the pathophysiology is unknown. This study was designed to investigate the local effects of orlistat, free fatty acids, and the effects of the physical properties of rectal contents on anorectal function and continence. METHODS: Anorectal physiology and continence function were assessed in ten healthy patients after the application of four test enemas: 1) high-viscosity stool substitute, 2) stool substitute with free fatty acid, 3) low-viscosity oil with placebo, 4) oil with orlistat. Rectal function and capacity were assessed by barostat techniques. Anal resting pressure, squeeze pressure, and squeeze duration were assessed by manometry. A retention test was performed using the same enemas as a quantitative assessment of continence. RESULTS: Orlistat and free fatty acid had no adverse effects on anorectal function or continence. For each enema, the maximum volume retained correlated with rectal capacity (r = 0.85; P < 0.01). Continence during rectal filling was better maintained for high-viscosity stool substitute than low-viscosity oil enemas (P < 0.03). Patients able to maintain effective squeeze pressure retained more of the low-viscosity enemas than those with short squeeze duration (P < 0.01); in contrast, the volume retained of high-viscosity enemas was unaffected by anal sphincter function. CONCLUSIONS: The physical properties of rectal contents, rectal capacity, and voluntary anal sphincter function have effects on continence function in healthy patients. The occurrence of spotting may depend on both intrinsic anorectal function and the effects of orlistat on the volume and physical properties of stool.

Fox M, Thumshirn M, Menne D, Stutz B, Fried M, Schwizer W. · Department of Gastroenterology and Hepatology, University Hospital of Zürich, Zürich, Switzerland Menne Biomed, Tübingen, Germany. · Aliment Pharmacol Ther. · Pubmed #14984378 links to  free full text

Abstract: BACKGROUND: The intermittent loss of oil or liquid faeces ('spotting') is an adverse effect that occurs in obese patients during treatment with the lipase inhibitor orlistat; the pathophysiology is unknown. AIM: To investigate the effects of orlistat on anorectal sensorimotor function and continence. METHODS: Obese subjects susceptible to spotting were identified by an unblind trial of orlistat. Obese spotters (n = 15) and non-spotters (n = 16) completed a randomized, double-blind, cross-over trial of orlistat and placebo. Anorectal function was assessed by rectal barostat and anal manometry, together with a novel stool substitute retention test, a quantitative measurement of faecal continence. RESULTS: Orlistat increased stool volume and raised faecal fat and water. Treatment had no effect on anorectal motor function, but rectal sensation was reduced; on retention testing, the volume retained was increased. Subjects susceptible to spotting had lower rectal compliance, heightened rectal sensitivity and weaker resting sphincter pressure than non-spotters. On retention testing, gross continence was maintained; however, spotters lost small volumes of rectal contents during rectal filling. CONCLUSION: Treatment with orlistat has no direct adverse effects on anorectal function or continence. Spotting occurs during treatment with orlistat when patients with sub-clinical anorectal dysfunction are exposed to increased stool volume and altered stool composition.

Kasalický M, Fried M, Pesková M. · I. chirurgická klinika 1. lékarské fakulty Univerzity Karlovy a Vseobecné fakultní nemocnice, U Nemocnice 2, 128 08 Praha 2, Czech Republic. · Sb Lek. · Pubmed #12688144 No free full text.

Abstract: The gastric bandage is reliable method for long time control of weight loss in failed conservative cure of morbid obese patients. Since 1983 we have been concerned with bariatric surgery at the First Surgical Department of General Faculty Hospital of Charles University. 691 morbid obese patients (BMI 49.7 kg/m2, mean age of 38.1) underwent gastric banding (GB)--by laparotomy 58 obese patients and since 1993 by laparoscopy 633 obese patients. After 12 months the mean weight loss was 21.1 kg (14-32 kg) and after 24 month the mean weight loss was 38.7 kg (27-73 kg). In period of 1993-1998 the most frequent late complication in the group of 517 obese patients after laparoscopic nonadjustable gastric banding (LNGB) was in 5.1% dilatation of upper gastric pouch or slippage of anterior stomach wall above the band with vomiting and failure of gastric evacuation. In majority we removed GB laparoscopically. To prevent this complication we modified GB with fixing band with a cuff made from the anterior gastric wall. To test the effectiveness of this method we implemented in 1998-1999 a prospective randomized study. In the group of 80 morbid obese patients we created in 40 patients (n1-GB+C) LNGB with the cuff fixation and in 40 patients (n2-GB-C) without fixation. We followed-up of this patients after LNGB was in 6 weeks, 6 months and 12 months with measurement of pouch volume by endoscopy with calibrate endocannula. One year after GB in the group n1-GB+C the mean increase of the pouch volume was 14.6 ml, i.e. 124% of the original size, while in group n2-GB-C the mean increase of the pouch volume was 33.6 ml, i.e. 154.1% of the original size. The slippage or dilatation of the pouch was in group nl in one case while in group n2 in three cases (p < 0.001).

Kasalický M, Fried M, Pesková M, Bortlík M, Votrubová J. · I. chirurgická klinika VFN 1. LF UK, Praha. · Rozhl Chir. · Pubmed #10916444 No free full text.

Abstract: We have been concerned with bariatric surgery at the First Surgical Clinic of th General Faculty Hospital, First Medical Faculty, Charles University Prague since 1983. In 1983-1986 vertical gastroplasties were made, between 1986 and 1993 non-adjustable gastric bands were provided by the laparotomic approach. Since 1993 when we were the first to implement a gastric band operation (GB) by the laparoscopic route, this method is used as the standard method. In 1993-1998 we made at the First Surgical Clinic 517 laparoscopic GB operation on account of morbid obesity in patients with a body mass index of 34-49 kg/m2. The group comprised 449 women and 59 men. The most frequent late complication in our group of morbidly obese patients who had a laparoscopically administered GB was in 5.1% enlargement of the proximal pouch above the GB by dilatation of its wall or slippage of the anterior wall proximally under the GB with a subsequent disorder of gastric evacuation and vomiting. We tried to reduce the incidence of this complication by fixing the GB by a cuff made from the anterior gastric wall. To test the effectiveness of the suggested fixation of the non-adjustable GB by a cuff we implemented in 1998-1999 a prospective randomized study in a group of 80 morbidly obese patients divided into experimental group n1-GB + C with the cuff and a control group n2-GB - C without a cuff. We investigated the incidence of the mentioned complication and the changed volume of the pouch above the GB after one year. Endoscopic assessment of the size of the pouch above the GB after surgery and after one year revealed that in group n1-GB + C the mean increase of the pouch volume was 14.6 ml, i.e. 124% of the original size, while in group n2-GB - C the mean increase of the volume was 33.6 ml, i.e. 154.1% of the original size (p < 0.001). Based on the assembled results and aware of the fact that small groups were involved, we should like to express the assumption that the suggested modification, i.e. fixation of a non-adjustable GB by a cuff made from the anterior gastric wall can reduce the incidence of the complication of slippage of the anterior gastric wall proximally above the bandage.

Fried M, Hainer V, Basdevant A, Buchwald H, Dietel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. · Klinické centrum pro minimálne invazivní a bariatrickou chirurgii ISCARE a Univerzita Karlova--1.lékarská fakulta, Praha, Ceská republika. · Rozhl Chir. · Pubmed #19174948 No free full text.

This publication has no abstract.

Fried M. · Clinical Center for Minimally Invasive and Bariatric Surgery Iscare-Lighthouse, Prague, Czech Republic. · Int J Pediatr Obes. · Pubmed #18850407 No free full text.

Abstract: Morbid obesity and its rapidly increasing prevalence has became a serious health, social and economic problem not only in Europe, but in other developed countries in the Western world. It is well recognized that conservative treatment usually fails in morbidly obese patients in the long-term. In severely obese patients, the only long-term effective treatment of their obesity and obesity related co-morbidities, such as type 2 diabetes mellitus, is bariatric surgery. However, there is neither consensus on how to treat morbidly obese adolescents (including bariatric surgery), nor existing specific child/adolescent guidelines on this topic. This article presents an overview of existing views on bariatric surgery in adolescents as well as some treatment results achieved with bariatric surgery.

Kasalicky M, Michalsky D, Housova J, Haluzik M, Housa D, Haluzikova D, Fried M. · First Surgical Department, Fist Medical Faculty, Charles University of Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic. · Obes Surg. · Pubmed #18649114 No free full text.

Abstract: BACKGROUND: In the past few years, laparoscopic sleeve gastrectomy (LSG) became a widely used bariatric method. Based on results of recent LSG studies, LSG is being increasingly used even as a single bariatric method. On contrary with some other reports, we do not reinforce the LSG staple line with over-sewing. Our pilot study presents treatment outcomes and results 18 months after LSG. METHODS: Sixty-one consecutive morbidly obese (MO) patients (19 male and 42 female) who underwent LSG from January 2006 to May 2008 were included into the study. The mean age, height, and weight were 37.3 years (29-57), 168 cm (151-187), and 118 kg (97-181), respectively, while mean body mass index (BMI) was 41.8 (36.1-60.4). LSG started at 6 cm from pylorus and ended at the angle of Hiss. For gastric sleeve calibration 38F, intragastric tube was used. All 61 LSG were performed without over-sewing of the staple line. In the last 24 cases, the staple line was covered with Surgiceltrade mark strips, which were however placed without any fixation to the underlying gastric tissue. RESULTS: Mean operating time was 105 min (80-170) and no conversion to open surgery. An 18-month follow-up was recorded in 39 MO patients. The mean weight loss was 31.3 (range, 21-67 kg) and mean % excess BMI loss reached 72% (range, 64-97%). Neither leak nor disruptions of the staple line and/or sleeve dilatation were recorded. CONCLUSION: LSG is an effective and safe bariatric procedure with low incidence of complications and mortality in our experience.

Fried M. · ISCARE - Center for Minimally Invasive and Bariatric Surgery, Teaching Facility 1st Medical Faculty, Charles University, Prague, Czech Republic. · Surg Obes Relat Dis. · Pubmed #18501311 No free full text.

Abstract: BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is a safe and effective bariatric operation for the treatment of morbid obesity. Optimized long-term weight loss and reduced complications may be facilitated by development of a standardized, accurate, band-fill measurement methodology for use in postoperative LAGB adjustments. METHODS: A summary of the primary in vitro, theoretical, and in vivo studies of pressure-volume theory relative to gastric banding was undertaken. RESULTS: LAGBs range in mechanisms of action from low-pressure/high-volume to high-pressure/low-volume. Use of both basic and dynamic pressure data obtained experimentally and clinically with a low-pressure/high-volume (LP/HV) band as a research tool revealed that intra-band pressures remained very low even when the band balloon was filled to its maximum fill volume; in contrast, when a high-pressure/low-volume (HP/LV) band was filled, it exhibited a pressure curve markedly steeper and of greater amplitude than that of the LP/HV band. Theoretical calculations of the differences between the bands in terms of the pressures they exerted on a bolus of food passing through a stoma found that the pressure created by the HP/LV band against the gastric wall was >100% higher than that applied by the LP/HV band; these mathematical results were verified by using invasive manometry in 35 patients undergoing band adjustment. In clinical testing, basic band pressure, band volume, and dynamic pressure data (that demonstrated esophageal motility patterns at the stoma during bolus passage) were gathered and correlated. As identified by intra-band pressure readings, a zone of disruptive peristaltic activity that obstructed bolus passage through the stoma was observed; slightly beneath this zone, it was hypothesized that successful patient adjustments might be carried out. The manometrically delineated measure of mean band pressure sufficient to exert a significant yet not disruptive restriction (i.e., 20 mm Hg; mean volume of 5.4 mL) was tested in 25 patients in follow-up. No patient required readjustment due to obstruction. Intra-band pressure, as opposed to band-fill-volume measurement, per se, was shown to produce a more accurate measurement of actual band (stoma) restriction in individual patients, and to identify a pressure "green zone" for effective restriction at adjustments. DISCUSSION: Ongoing scientific studies are needed to refine pressure-volume theory by using laboratory, theoretical, and clinical manometry to establish a reliable pressure-based algorithm for gastric band adjustment. Such an algorithm may lead to more consistent weight loss, fewer complications, and more compliant patients.

Spálová J, Zamrazilová H, Vcelák J, Vanková M, Lukásová P, Hill M, Hlavatá K, Srámková P, Fried M, Aldhoon B, Kunesová M, Bendlová B, Hainer V. · Institute of Endocrinology, Prague, Czech Republic. · Physiol Res. · Pubmed #18271693 links to  free full text

Abstract: Neuromedin beta (NMB) is a member of the bombesin-like peptide family expressed in brain, gastrointestinal tract, pancreas, adrenals and adipose tissue. The aim of our study was to compare the frequency of P73T polymorphism in overweight and obese patients (37 men: age 50.6+/-11.7 years, BMI 41.1+/-7.8 kg/m(2); 255 women: age 49.0+/-11.9 years, BMI 37.9+/-6.8 kg/m(2)) with that of healthy normal weight subjects (51 men: age 28.2+/-7.1 years, BMI 22.3+/-2.0 kg/m(2); 104 women: age 29.1+/-9.1 years, BMI 21.5+/-1.9 kg/m(2)) and to investigate the polymorphism's influence on anthropometric, nutritional and psychobehavioral parameters in overweight/obese patients both at the baseline examination and at a control visit carried out 2.5 years later, regardless of the patient s compliance with the weight reduction program. No significant differences in the genotype distribution were demonstrated between normal weight and overweight/obese subjects. Male T allele non-carriers compared to T allele carriers had higher energy (p=0.009), protein (p=0.018) and fat (p=0.002) intakes and hunger score (p=0.015) at the beginning of treatment. Male T allele non-carriers had a more favorable response to weight management at the follow-up, as they exhibited a significant reduction in waist circumference, energy intake and depression score as well as a significant increase in dietary restraint. No significant differences between carriers and non-carriers were demonstrated in women at the baseline examination. Both female T allele carriers and non-carriers demonstrated similar significant changes in nutritional parameters and in restraint score at the follow-up. Nevertheless, only female non-carriers showed a significant decrease in the hunger score.

Kormanova K, Fried M, Hainer V, Kunesova M. · Private Obesity Treatment Centre, ISCARE a.s., "Areal Havana", Mochovska 38, 190-00 Prague 9, Czech Republic. · Obes Surg. · Pubmed #15527641 No free full text.

Abstract: BACKGROUND: Laparoscopic adjustable gastric banding is the least invasive bariatric operation. However, just isolated attempts to perform this procedure as a Day Case have been published. This study highlights some aspects that might contribute to safe patient discharge within 23 hours after LAGB. METHODS: Prospective evaluation of 20 consecutive patients was carried out. Patients were indicated for laparoscopic Swedish adjustable gastric banding (SAGB, Obtech, Ethicon Endo-Surgery) in a private Bariatric center in the first 6 months of 2003. The effect of extensive pre- and immediate postoperative education and psychological support, and information on postoperative health consequences delivered through a multi-disciplinary bariatric team effort, was evaluated, regarding the influence of these facilitators in shortening the length of hospital stay. RESULTS: Mean preoperative BMI of the 20 patients entering the study was 42.3. Mean operating-time was 91 minutes (58-112 min). Time spent on information and education of each patient was 60 minutes in total during the preoperative period. Average postoperative hospitalization was 21 hours. There were no intraoperative or early postoperative complications. Excess weight loss was 44% at 12 months after surgery. CONCLUSION: SAGB performed on a Day Case basis in selected patients who are subjected to intensive pre- and immediate postoperative dedicated education appears to be a feasible alternative.

Fried M, Lechner W, Kormanova K. · Obesity Treatment Centre, ISCARE a.s., Prague, and 1st Medical Faculty Charles University Prague, Czech Republic. · Obes Surg. · Pubmed #15479603 No free full text.

Abstract: BACKGROUND: Commonly used adjustable gastric bands function on two different physical principles: low pressure-high volume and high pressure-low volume system. METHODS: A study was carried out to investigate the theoretical and clinical levels of adjustable band volume-pressure features and their possible influence on band-related complications. The theoretical study had two objectives: to define physical principles of impact of the band balloon on the gastric wall at the stoma region, and to apply a physical formula for calculating this data. The objectives of the clinical part of the study were to construct a simple reliable measuring device, enabling data collection on an out-patient basis from patients who had undergone gastric banding with the two band systems, to support or refute the theoretically calculated results. RESULTS: A physical formula calculated the pressure applied by the different band systems on the gastric wall in the stoma region. Calculations revealed a >100% difference in pressure caused by the respective bands. Invasive pressure measurements in 35 patients with the different balloon systems agreed with the calculated data, and found a >100% difference in pressure affecting the stoma wall both at rest and during meals. CONCLUSIONS: Differences in pressure on the gastric wall related to the physical system on which the bands operate may be a partial explanation for long-term complications of respective bands.

Fried M, Miller K, Kormanova K. · Centre for Obesity Treatment, Prague, Czech Republic. · Obes Surg. · Pubmed #15018757 No free full text.

Abstract: BACKGROUND: Gastric restriction is a treatment option for morbid obesity. Currently there are several types of adjustable gastric bands available, with two leading but conceptionally different systems, not just from a technical point of view but also from the long-term complication rates. METHODS: A literature search of articles published from January 1997 to December 2002 dealing with prospective or restrospective studies comparing results of treatment with the Swedish band and Lap-Band was carried out. RESULTS: 7 comparative studies fulfilled inclusion criteria, with a total of 1031 patients in the Swedish band (41-597) and 1305 patients in the Lap-band groups (34-821). Pouch dilatation/slippage and/or erosion in Swedish vs Lap-band were reported in the studies as follows: 1 vs 2 in study group 1, 0 vs 9 in study group 2, 0 vs 3 in 3, 3 vs 38 in 4, 0 vs 64 (slippages) and 4 vs 4 (erosions) in group 5. In study 6, 3 vs 3 dilatations and 0 vs 1 erosions were reported. Study 7 found 12 vs 42 long-term complications of this origin. Port-site infections, total reoperation rates and length of hospital stay were also compared. CONCLUSION: The results of this meta-analysis reveal that fall in BMI is similar with both laparoscopic bands. Long-term complication rates, despite the fact that they have been defined in a similar way in all the included studies, may be higher with more reoperation rates in Lap-band(R) patients.

Frasko R, Maruna P, Gürlich R, Fried M, Kasalický M, Chachkhiani I, Pesková M. · I. chirurgická klinika, 1. lékarské fakulty Univerzity Karlovy. · Sb Lek. · Pubmed #12688149 No free full text.

Abstract: Percutaneous electrogastrography (EGG) is a non-invasive measuring method of gastric myoelectrical activity. We measured myoelectrical activity patients after laparoscopic cholecystectomy (16 patients), after laparotomic cholecystectomy (9 patients) and after gastric bandage (14 patients). We used a Microdigitrapper (Medtronic) and data were analysed with a spectral analysis and Fournier's transformation. We measured 24 hours and 5 hours before operation procedure and 24 and 48 hours after operation. After operative procedure we compared results with healthy voluntaries. Bradygastria was found in most frequent cases in early postoperative period. Physiologic conditions were renewed in laparoscopic operative procedure in first day, after laparotomic operation in second day after operation.

Danzig V, Krska Z, Linhart A, Sváb J, Pesková M, Demes R, Polívková J, Fried M. · I. interní klinika 1. lékarské fakulty Univerzity Karlovy, U nemocnice 2, 128 08 Praha 2, Czech Republic. · Sb Lek. · Pubmed #12688148 No free full text.

Abstract: AIM: To evaluate response of cardiovascular system in laparoscopic surgery. The main aim was: 1--comparison of healthy subjects and morbid obese population, 2--comparison of healthy subjects and cohort of patients with organic cardiopathy. Secondly we compared the influence of the operation position. PATIENTS AND METHODS: Patients (n = 17) were divided into 3 subgroups:--Control group of "normal" subjects: mean age 36.8 +/- 11.2 years; BMI 25.33 +/- 3.62; BSA 1.84 +/- 0.21 m2; two men and four women; op. diagnosis: 3x cholecystectomy, 1x appendectomy, 1x inguinal herniotomy, 1x hiatal hernia operation. --Group of patients with morbid obesity: mean age 38 +/- 8.1 years; BMI 45.82 +/- 7.54!; BSA 2.66 +/- 0.32 m2; one man and five women; all of them were operated for obesity (laparoscopic gastric banding).--Group of patients with severe cardiopathy: mean age 64.0 +/- 11.55; BMI 26.4 +/- 4.09; BSA 1.89 +/- 0.23; three men and two women; card. diagnosis: 2x aortic stenosis, 1x combined aortic valvulopathy, 1x aortic stenosis with secondary mitral regurgitation, 1x secondary mitral regurgitation (both caused by coronary artery disease); op. diagnosis: 4x cholecystectomy; 1x extraction of catheter for peritoneal dialysis. The method of our examination was transesophageal echocardiography with use of omni planar sond with continual monitoring of each patient. Our data are based on repeated measurements (3x minimal for each state and each patient) before and after peritoneal cavity insufflation and third after positioning of patient (in Trendelenburg or Fowler position). Examinations were recorded and data analysed off-line. Following parameters were analysed: mean age, BMI, BSA, heart rate, mean arterial pressure (MAP), ejection fraction of left ventricle (EF), E/A ratio of transmitral flow, cardiac output (CO), cardiac index (CI), systemic (peripheral) vascular resistance (SVR) and pressure-rate-product (PRP). For statistical analysis were used: ANOVA tests, t-tests with Benforroni correction and Friedman's tests. RESULTS AND DISCUSSION: In comparison of normal and obese patients statistically significant differences were found (after exclusion of BMI and BSA) in cardiac output values, after recalculation on body surface (cardiac index) remained only non-significant trend to fall. Differences between control group and group of cardiacs were also non significant with exclusion of E/A ratio of transmitral flow. This result we explain by pseudonormalization. All 17 operations were successfully done without any complication. CONCLUSIONS: Our data were obtained on relatively small cohort of patients but the number of patients was respected by statistics and results might be borderline but significant. Laparoscopic gastric band (operation is done in semi-sitting position) in morbid obese patients is well tolerated without any differences in comparison to healthy population. The population of patients with severe organic cardiopathy needs careful approach. Our data are favourable but significant change in the left ventricle filling together with non-significant hemodynamic disadvantageous trends in EF, CI and MAP requires care. Further investigations are needed and with intraoperative monitoring (transesophageal echocardiography is preferred) can be considered as safe.

Kasalický MA, Sváb J, Fried M, Melechovský D. · I. chirurgická klinika VFN a 1. LF UK, Praha. · Rozhl Chir. · Pubmed #12197168 No free full text.

Abstract: At present the most widely used system of CAS is a vocally controlled manipulator of the laparoscope AESOP 3000 (Automated Endoscopic System for Optimal Positioning) which makes it possible to implement some operations without the assistance of another surgeon ("Solo-surgery"). Because of financial costs the so far little used equipment ZEUS or DA VINCI are already "master-slave" systems with several robot arms where the surgeon operates by means of manipulators in the controlling unit without direct contact with the patient. At the First Surgical Clinic, General Faculty Hospital and First Medical Faculty Charles Universitx the authors use the robot system AESOP 3000 since March 2000, in particular in laparoscopic gastric banding on account of obesity, in laparoscopic cholecystectomies, laparoscopic gastroenteroanastomoses and operations in the area if the hiatus. This system made it possible to reduce the number of assisting physicians. E.g. in gastric banding one assistant is sufficient, in laparoscopic cholecystectomy it is possible to operate only with a suture nurse. The application of AESOP is particularly useful in laparoscopic appendectomies and inguinal hernioplasties where it makes possible so-called "solo-surgery" or "one man surgery". No doubt, it is however necessary to have the possibility to call immediately another doctor to the operation theatre in case of necessary conversion of laparoscopy of laparotomy. The authors did not record any case of unwanted movement of the robot arm or another serious technical problem. As compared with a manually guided laparoscope during the use of AESOP the number of unwanted or inadequate shifts of the optical equipment or its angular rotation decreased considerably.

Kasalický M, Fried M, Pesková M. · I. chirurgická klinika VFN a 1. LF UK, U nemocnice 2, 128 08 Praha 2, Czech Republic. · Sb Lek. · Pubmed #12092094 No free full text.

Abstract: Approximately 16% of male and 20% of female of the age from 20 to 65 years are obese in the Czech Republic. The restrictive bariatric procedure of stomach--gastric banding (GB) is one of possibilities to cure the morbid obese patients after failure of conservative therapy. The ratio of complications (5-18%) after GB presenting in various papers is comparable with the ratio of complications (4-23%) in others bariatric procedures. From 1993 to 1999, 517 morbid obese patients (mean BMI 51.1) underwent laparoscopic nonadjustable gastric banding (LNGB) at 1st Surgical Department, Charles University Teaching Faculty Hospital in Prague. As the early complications (during hospitalization) offered swelling of the gastric mucous in the place of GB in 5.6% (n = 29), the oesophagitis, the gastritis or the gastric ulcer in 1.5% (n = 9) and perforation of the stomach wall in 0.6% (n = 3). As the late complications offered the bleeding from peptic ulcer in 0.4% (n = 2), sequential migration of gastric band through the stomach wall inside in 0.6% (n = 3) and the slippage of anterior stomach wall or the dilatation of the pouch above gastric bandage in 5.1% (n = 26). The serious complications in 6.3% (n = 32) claimed surgical procedures. Other complications in 7.5% (n = 39) have been treated conservatively. The 86% (n = 446) of obese patients after LNGB were without complications.

Kasalický M, Fried M, Pesková M. · I. chirurgická klinika VFN a 1. LF UK, U nemocnice 2, 128 08 Praha 2, Czech Republic. · Sb Lek. · Pubmed #12092093 No free full text.

Abstract: Problems of extreme and morbid obesity take on constantly considerable relevance in 21st century. The prevalence of the obesity (BMI--Body Mass Index > 30 kg/m2) is still on the increase worldwide. In the Czech Republic approximately 16% of male and 20% of female in the age of 20-65 years are obese (BMI > 30 kg/m2). To begin with the effective cure is always indicate in case of the obesity over BMI > 30. The bariatric surgery is indicating in the occurrence of failure of conservative care of morbidly obese patients with recurrences of overweight. The morbid obesity with serious associate health complications often represents the vital danger of the patient's life. The development of the bariatric surgery passed from resections of the bowel, gastric bypasses, biliopancreatic diversions, horizontal gastroplasties to in the present the most frequently used methods as the vertical bandage gastroplasty (VBG) and the gastric bandage (GB). The standard applications of the miniinvasive laparoscopic methods with significant decrease of postoperative complications radical changes of the bariatric surgery in the present years.