Sleep Apnea Syndromes: Jones DB

Jones DB, Provost DA, DeMaria EJ, Smith CD, Morgenstern L, Schirmer B. · Harvard Medical School, Section of Minimally Invasive Surgery, Bariatric Program, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. · Surg Endosc. · Pubmed #15162240 No free full text.

Abstract: BACKGROUND: Obesity is a growing health problem that contributes to numerous life-threatening or disabling disorders, including coronary artery disease, hypertension, type 2 diabetes mellitus, hyperlipidemia, degenerative joint disease, and obstructive sleep apnea. Significant weight reduction in the morbidly obese improves or reverses associated illness and benefits well-being. The purpose of the SAGES Appropriateness Conference was to summarize the state of the art for open and laparoscopic operations for the morbidly obese. METHODS: The English literature comparing bariatric procedures was reviewed and grouped by level of evidence by three surgeons (BS, LV, and CC). From more than 1,500 articles, all conference participants were provided with reprints and table summaries of no less than 50 selected manuscripts. Ten experts were requested to present reviews and make evidence-based arguments for and against the open and laparoscopic approaches in written format. An expert panel of six surgeons, including an ethicist and patient, commented on implications of data presented. The finalized statement was e-mailed to all participants for approval and comment. RESULTS: Consensus statements were achieved on various aspects of morbid obesity, including indications for surgery, resolution of comorbid illnesses with significant weight loss, and the importance of committed bariatric program. Our panel of experts agreed, in general, to the advantages of laparoscopic approaches compared to open operations in skilled hands. CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass (RYGB) affords improved short-term recovery compared to open gastric bypass. Laparoscopic adjustable banding can be performed with lower average mortality than either RYGB or any of the malabsorptive operations, and it produces variable degrees of short-term weight loss. Prospective randomized trials are needed to compare gastric bypass, malabsorptive, and restrictive procedures.

Edwards MA, Jones DB, Ellsmere J, Grinbaum R, Schneider BE. · Assistance Professor of Surgery, Medical College of Georgia, Augusta, GA, USA. · Obes Surg. · Pubmed #17546834 No free full text.

Abstract: BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the most commonly performed operation for the treatment of morbid obesity in the United States. Previous reports suggest that postoperative complications may be influenced by Roux limb orientation (antecolic versus retrocolic), although this remains controversial. The aim of this study was to analyze our experience with anastomotic leaks following LRYGBP with an antecolic- versus retrocolic-routed Roux limb. METHODS: During the 2-year period of June 2003 to June 2005, 353 patients underwent a LRYGBP. 135 were antecolic and 218 retrocolic. All cases were performed by one of three bariatric surgeons. The decision to perform antecolic versus retrocolic LRYGBP was left to the surgeon's preference. The primary outcome measure was anastomotic leak. RESULTS: Mean follow-up was 28 weeks. There were no perioperative deaths. Overall complication rate was 16.9%. 17 gastrojejunal leaks (4.8%) were identified, consisting of 12 intraoperative leaks (3.4%) and 5 postoperative leaks (1.4%). Postoperative gastrojejunal leak rate was higher in the antecolic group (P=0.04). CONCLUSION: Mortality and complication rates were consistent with reported benchmarks on the efficacy and safety of LRYGBP. Our review suggests that anastomotic leak may be more common after antecolic than after retrocolic LRYGBP for morbid obesity. A prospective randomized study is needed to determine whether antecolically-routed Roux limb is an independent predictor for anastomotic leak following LRYGBP.