Band Surgery Research Articles

BAND SURGERY ON KNOTS AND LINKS, II

An oriented 2-component link is called band-trivializable, if it can be unknotted by a single band surgery. We consider whether a given 2-component link is band-trivializable or not. Then we can completely determine the band-trivializability for the prime links with up to 9 crossings. We use the signature, the Jones and Q polynomials, and the Arf invariant. Since a band-trivializable link has 4-ball genus zero, we also give a table for the 4-ball genus of the prime links with up to 9 crossings. Furthermore, we give an additional answer to the problem of whether a (2n + 1)-crossing 2-bridge knot is related to a (2, 2n) torus link or not by a band surgery for n = 3, 4, which comes from the study of a DNA site-specific recombination.

Dry Beriberi and Wernicke’s encephalopathy following gastric lap band surgery

The incidence of neurologic complications from bariatric surgery is rising with the prevalence of obesity and the increasing number of bariatric surgeries. We report a 25-year-old woman who developed subacute progressive weakness and areflexia followed by confusion, ophthalmoplegia, and nystagmus following bariatric surgery. While the differential of generalized weakness with altered mental status is broad, vitamin deficiency should be routinely suspected after bariatric surgery to prevent permanent neurological injury. Multifocal neurological dysfunction in our patient represented beriberi and Wernicke’s encephalopathy related to vitamin B1 deficiency.

Changes in weight and co-morbidities among adolescents undergoing bariatric surgery: 1-year results from the Bariatric Outcomes Longitudinal Database

BackgroundBariatric surgery is 1 of the few effective treatments of morbid obesity. However, the weight loss and other health-related outcomes for this procedure in large, diverse adolescent patient populations have not been well characterized. Our objective was to analyze the prospective Bariatric Outcomes Longitudinal Database (BOLD) to determine the weight loss and health related outcomes in adolescents. The BOLD data are collected from 423 surgeons at 360 facilities in the United States. MethodsThe main outcome measures included the anthropometric and co-morbidity status at baseline (n = 890) and at 3 (n = 786), 6 (n = 541), and 12 (n = 259) months after surgery. Adolescents (75% female; 68% non-Hispanic white, 14% Hispanic, 11% non-Hispanic black, and 6% other) aged 11 to 19 years were included in the present analyses. ResultsThe overall 1-year mean weight loss for those who underwent gastric bypass surgery was more than twice that of those who underwent adjustable gastric band surgery (48.6 versus 20 kg, P < .001). Similar results were found for all other anthropometric changes and comparisons within 1 year between surgery types (P < .001). In general, the gastric bypass patients reported more improvement than the adjustable gastric band patients in co-morbidities at 1 year after surgery. A total of 45 readmissions occurred among gastric bypass patients and 10 among adjustable gastric band patients, with 29 and 8 reoperations required, respectively. ConclusionsThe weight loss at 3, 6, and 12 months after surgery is approximately double in adolescent males and females who underwent gastric bypass surgery versus those who underwent adjustable gastric band surgery. Bariatric surgery can safely and substantially reduce weight and related co-morbidities in morbidly obese adolescents for ≥1 year.

Diode Laser for Treatment of Symptomatic Hemorrhoid: A Short Term Clinical Result of a Mini Invasive Treatment, and One Year Follow Up

Hemorrhoid is protrusion of plexus or blood vessels in the anal canal. The hemorrhoid may cause symptoms that are: bleeding, pain, prolaps, itching, soilage of feces, and psychologic discomfort. There are many methods for treatment of hemorrhoid like, medical therapy, cryo-therapy, rubber band ligation, sclerotherapy, laser, and surgery. All methods have some complication in postoperative period and recurrence. Was to evaluate Diode laser for treatment of hemorrhoid. This study included patients who suffer from the hemorrhoid. Cases with fistula and fissure had been omitted. Patients with hemorrhoid in grade 2, 3, 4 and mixed were treated with diode laser. Follow up was done 1,7,14, 30, 90, and 360 days laser therapy. In this study, 341 patients with hemorrhoid treated with diode laser were included. Results of follow-up were as follows: need for analgesia in hospital stay and home was very low total complication was seen in 12 patient (3.51%), edema in 8 patient (2.34%), hemorrhage and abscess each of them in 2 patient (0.58%), stricture and recurrence was zero after one year. All methods used for hemorrhoid treatment has advantages, disadvantages, and limitations. But treatment of hemorrhoid by Diode laser, which is done by skilled surgeon has several advantages over other treatments. This advantages include, less operation time, less pain and bleeding, allow quick healing of piles, no stricture, and minimal recurrence after operation.

Aspiration pneumonia secondary to laparoscopic adjustable gastric band surgery

Internal Medicine JournalVolume 42, Issue 1 p. 108-111 Aspiration pneumonia secondary to laparoscopic adjustable gastric band surgery B. R. Jennings, B. R. Jennings Respiratory and Sleep MedicineSearch for more papers by this authorY. Kuok, Y. Kuok Radiology Department, Royal Melbourne HospitalSearch for more papers by this authorM. Qian, M. Qian Respiratory and Sleep MedicineSearch for more papers by this authorS. Heinze, S. Heinze Radiology Department, Royal Melbourne HospitalSearch for more papers by this authorL. B. Irving, L. B. Irving Respiratory and Sleep Medicine University of Melbourne, Melbourne, Victoria, AustraliaSearch for more papers by this author B. R. Jennings, B. R. Jennings Respiratory and Sleep MedicineSearch for more papers by this authorY. Kuok, Y. Kuok Radiology Department, Royal Melbourne HospitalSearch for more papers by this authorM. Qian, M. Qian Respiratory and Sleep MedicineSearch for more papers by this authorS. Heinze, S. Heinze Radiology Department, Royal Melbourne HospitalSearch for more papers by this authorL. B. Irving, L. B. Irving Respiratory and Sleep Medicine University of Melbourne, Melbourne, Victoria, AustraliaSearch for more papers by this author First published: 26 January 2012 https://doi.org/10.1111/j.1445-5994.2011.02592.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume42, Issue1January 2012Pages 108-111 RelatedInformation

Laparoscopic management of gastric band erosions: a 10-year series of 49 cases

Intragastric erosion is a rare but major complication of laparoscopic adjustable gastric band (LAGB) surgery for morbid obesity. Many techniques to treat this problem have been described, with little supporting evidence. The authors review their experience with laparoscopic removal of eroded gastric bands. The prospectively collected bariatric surgery database of the authors' practice was queried for the period January 2000 until February 2011, and the medical records for all patients with the diagnosis of band erosion were reviewed. Symptoms, time to erosion, interval between diagnosis and treatment, and complications of treatment were reviewed. All patients had undergone laparoscopy, cut-down onto the band, unclasping or division of the band near the buckle, removal of the band, and primary closure of the gastrotomy with omental patch reinforcement. During the study period, 2,097 LAGB operations were performed and 53 (2.53%) of these resulted in intragastric erosion. All the bands placed were LapBands (Allergan, Inc., Irvine, CA, USA). Erosions occurred with 14 of the 10-cm bands, 11 of the Vanguard bands, 14 of the AP Small bands, and 14 of the AP Large bands. Three patients elected to have their revisional surgery elsewhere and thus were lost to follow-up evaluation. One patient declined to have her band removed. The remaining 49 patients were included in the analysis. The mean time from band placement to the diagnosis of erosion was 31.5 months, and the mean time from diagnosis to band removal was 32 days. The mean hospital stay was 4 days. The complications included one postoperative leak, four superficial wound infections, and one pleural effusion. There were no deaths. This review demonstrates the safety of laparoscopic removal of eroded gastric bands with primary closure and omental patch repair. The time from diagnosis of erosion to treatment can be short, in contrast to endoscopic removal, in which the requirement for further erosion of the band to free the buckle often necessitates delayed treatment.

Does adding a lesser-curvature gastrogastric plication suture reduce the need for revision after laparoscopic adjustable gastric band placement?

The need for revision after laparoscopic adjustable gastric band (LAGB) surgery has been reduced over the past 10 years with the introduction of the pars flaccida technique, delicate band tightening, and concurrent hiatal hernia repairs. However, band revision still occurs for as many as 5% of patients. Placement of a lesser-curvature gastrogastric suture distal to the band is one newer technique suggested to lower band slippage. To evaluate the worth of this technique, the authors have investigated two groups of patients in their practice: one group with the plication stitch and one group without it. This retrospective review examined data for 1,365 LAGB patients collected prospectively by an institutional review board-approved database between July 2007 and May 2010. One surgeon did not perform the plication stitch (n = 776) and one did (n = 589). The surgical techniques were very similar. The majority of the patients had crural repair at the primary operation. Band revision rates were assessed. For 1,365 patients, LAGB was performed safely. The mean follow-up period was 22 months. The two groups were similar. The no-stitch group consisted of 776 patients (496 women, 64%) with a mean age of 42 years, a mean weight of 278 lb, and a mean body mass index (BMI) of 44.6 kg/m(2). The stitch group consisted of 589 patients (426 woman, 72%) with a mean age of 40 years, a mean weight of 278 lb, and a mean BMI of 44.8 kg/m(2). The no-stitch group had an estimated weight loss (EWL) of 44% at 12 months and 50% EWL at 2 years. The stitch group had 37% EWL at 12 months and 45% EWL at 2 years. Both groups had very low revision rates. The no-stitch group had 4 revisions in 776 patients (0.26%), and the stitch group had 9 revisions in 589 patients (1.5%). Adding gastrogastric plication sutures offers no benefit of reducing the rate of revision after LAGB surgery.

Predicting sleep apnea in bariatric surgery patients

Background Because of the high prevalence and potentially serious complications of obstructive sleep apnea (OSA) in obese individuals, several prediction models have been developed to detect moderate-to-severe OSA in patients undergoing bariatric surgery. Using commonly collected variables (body mass index [BMI], age, observed sleep apnea, hemoglobin A1c, fasting plasma insulin, gender, and neck circumference), Dixon et al. developed a model with a sensitivity of 89% and specificity of 81% for patients undergoing laparoscopic adjustable gastric band surgery suspected to have OSA. The present study evaluated the prediction model of Dixon et al. in 310 gastric bypass patients (mean BMI 46.8 kg/m 2, age 41.6 years, 84.5% women), with no preselection for OSA symptoms in a bariatric surgery partnership. Methods The patients underwent overnight limited polysomnography to determine the presence and severity of OSA as measured using the apnea-hypopnea index. Results Of the 310 patients, 44.2% had moderate-to-severe OSA (apnea-hypopnea index ≥15/h). Most variables in the Dixon model were associated with a greater prevalence of OSA. The sensitivity (75%) and specificity (57%) for the model-based classification of OSA were considerably lower in the present sample than originally reported. An alternate prediction model identified 10 unique predictors of OSA. The presence of ≥5 of these predictors modestly improved the sensitivity (77%) and greatly improved the specificity (77%) in predicting an apnea-hypopnea index of ≥15/h. When applied to the validation sample, the sensitivity (76%) and specificity (72%) were essentially the same. Conclusion Although the Dixon model and our model included overlapping predictors (BMI, gender, age, neck circumference), when applied in our sample of gastric bypass patients, neither model achieved the sensitivity and specificity for predicting OSA previously reported by Dixon et al.

A07. Re-operation rates following laparoscopic gastric band surgery for morbid obesity

A07. Re-operation rates following laparoscopic gastric band surgery for morbid obesity

Band Surgeries between Knots and Links with Small Crossing Numbers

In DNA site-specific recombination, an enzyme attaches to a pair of DNA sites, and recombines the sites to different ends. During site-specific recombination, the topology of circular DNA can change, forming knots and links. We model Xer recombination as band surgery. By regarding Xer recombinations as band surgeries and applying mathematical results on band surgery, we confirm experimental results of Xer recombination acting on circular DNA. In particular, our motivation is the unlinking of DNA catenanes by Xer-dif-FtsK recombinations reported by Grainge et al.,6) and Xer recombination at the psi-site on DNA catenanes with 2k crossings which yields DNA knots with 2k + 1 crossings reported by Bath, Sherratt and Colloms.1) The main result of this paper is summarized in Table II of band surgeries between knots with 7 and fewer crossings and catenanes with 8 and fewer crossings. In §2, we relate band surgeries to site-specific recombinations. In §3, we give the table which characterize band surgeries. In §4, we give a table for band surgery between knots. For knots with 7 and fewer crossings, we use the classical notation as in the book by Rolfsen (see Appendix C in 14)). For a knot or link K, we denote by K! the mirror image of K throughout this paper. We use several invariants of knots and links to construct Table II (see Theorems 3.4, 3.5, 3.7, 3.9, 3.11, and 3.13).

BAND SURGERY ON KNOTS AND LINKS

We give some relationships of the Jones and Q polynomials between two links which are related by a band surgery. Then we consider two applications: The first one is to an evaluation of the ribbon-fusion number, the least fusion number of a ribbon knot. The second one is to DNA knot theory, helping us to understand the action of the Xer site-specific recombination at psi site.

Validation of a novel laparoscopic adjustable gastric band simulator

Morbid obesity accounts for more than 90,000 deaths per year in the United States. Laparoscopic adjustable gastric banding (LAGB) is the second most common weight loss procedure performed in the US and the most common in Europe and Australia. Simulation in surgical training is a rapidly advancing field that has been adopted by many to prepare surgeons for surgical techniques and procedures. The aim of our study was to determine face, construct, and content validity for a novel virtual reality laparoscopic adjustable gastric band simulator. Twenty-eight subjects were categorized into two groups (expert and novice), determined by their skill level in laparoscopic surgery. Experts consisted of subjects who had at least 4 years of laparoscopic training and operative experience. Novices consisted of subjects with medical training but with less than 4 years of laparoscopic training. The subjects used the virtual reality laparoscopic adjustable band surgery simulator. They were automatically scored according to various tasks. The subjects then completed a questionnaire to evaluate face and content validity. On a 5-point Likert scale (1 = lowest score, 5 = highest score), the mean score for visual realism was 4.00 ± 0.67 and the mean score for realism of the interface and tool movements was 4.07 ± 0.77 (face validity). There were significant differences in the performances of the two subject groups (expert and novice) based on total scores (p < 0.001) (construct validity). Mean score for utility of the simulator, as addressed by the expert group, was 4.50 ± 0.71 (content validity). We created a virtual reality laparoscopic adjustable gastric band simulator. Our initial results demonstrate excellent face, construct, and content validity findings. To our knowledge, this is the first virtual reality simulator with haptic feedback for training residents and surgeons in the laparoscopic adjustable gastric banding procedure.

Direct Trocar Insertion Technique for Initial Access in Morbid Obesity Surgery: Technique and Results

Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in morbidly obese patients. There is no clear consensus as to the optimal method of entry into the peritoneal cavity. This study assesses the safety and feasibility of the direct trocar insertion technique without pre-existing pneumoperitoneum in patients undergoing laparoscopic bariatric surgery. From February 2006 to July 2009, 155 morbidly obese patients underwent laparoscopic adjustable gastric band surgery. There were 128 women (82.6%) and 27 men (17.4%). The mean age was 41 and ranged between 18 and 59 years. All patients met the National Institutes of Health criteria for bariatric surgery. The mean body mass index was 45 kg/m (range 35 to 61). There was no evidence of intestinal or vascular injury during trocar placement. Immediate minor complications were extraperitoneal insufflations in 5 patients, gastric serosal laceration in 1 patient, and left liver lobe laceration in 1 patient. No major complications were associated with this technique. All complications related to the direct trocar insertion technique were minor and these complications did not affect the success of surgery. We concluded that the direct trocar technique for initial access in laparoscopic bariatric surgery provides safe and quick entry into the peritoneal cavity.

"The solution needs to be complex." Obese adults' attitudes about the effectiveness of individual and population based interventions for obesity.

BackgroundPrevious studies of public perceptions of obesity interventions have been quantitative and based on general population surveys. This study aims to explore the opinions and attitudes of obese individuals towards population and individual interventions for obesity in Australia.MethodsQualitative methods using in-depth semi-structured telephone interviews with a community sample of obese adults (Body Mass Index ≥30). Theoretical, purposive and strategic recruitment techniques were used to ensure a broad sample of obese individuals with different types of experiences with their obesity. Participants were asked about their attitudes towards three population based interventions (regulation, media campaigns, and public health initiatives) and three individual interventions (tailored fitness programs, commercial dieting, and gastric banding surgery), and the effectiveness of these interventions.ResultsOne hundred and forty two individuals (19-75 years) were interviewed. Participants strongly supported non-commercial interventions that were focused on encouraging individuals to make healthy lifestyle changes (regulation, physical activity programs, and public health initiatives). There was less support for interventions perceived to be invasive or high risk (gastric band surgery), stigmatising (media campaigns), or commercially motivated and promoting weight loss techniques (commercial diets and gastric banding surgery).ConclusionObese adults support non-commercial, non-stigmatising interventions which are designed to improve lifestyles, rather than promote weight loss.

Understanding and expressing “Risk”

Making a decision to adopt or reject an intervention based on the evidence driven from medical literature, requires a clear understanding of the risk of adverse outcome and its relation (association) to this intervention. For example to choose a particular anti-arrythemic drug therapy may be based on the relation of this drug in reducing the risk of mortality. Expressing this concept might be done in several methods. Surprisingly, these different methods for expressing the same fact may lead to somewhat different understanding (and hence decisions) by the health practitioners. Assume that the mortality risk related to cardiac event in diabetic patients of average normal weight above 60 years is 20% within 5 years. If this estimation becomes true then in each 100 patients, 20 patients will die within 5 years. That example introduced the first term of risk which is the “event rate” or ER. Let us now consider in these patients a hypothetical condition of overweight where each extra 1 kg above the average weight constitutes a cardiac hazard that leads to an extra 1% increase in mortality (compared to the population with normal weight) related to cardiac event. So if you have a similar group in which each patient has an extra 100 kg weight, this will increases their risk by 100% and their expected ER will be doubled to = 40% i.e., from 100 patients, 40 will die within 5 years. The patient new base line expected risk is 40%. Now, suppose that you are studying certain interventions (like surgical procedure as gastric band versus diet control). If the diet failed to make any weight loss, while gastric band operation lead to loss of 25 kg in weight. There are several methods that the patient can express this weight loss. One may say 1. I Lost 25 kg. This is my absolute weight loss (weight difference). 2. I am now 75% compared to my extra weight before (weight ratio). 3. I have 25% reduction relative to my base line extra weight (relative weight reduction). Similar to these expressions, EBM expression are used to express this decrease risk of outcome as shown in Table 1. Table 1 Hypothetical examples of different risk parameters. 2. Event Rate (ER) The simplest measure of association to understand is the risk (or absolute risk). We often refer to the risk of the adverse outcome in the control group as the baseline risk or the control event rate (CER). When you apply intervention that changes the risk to a new event rate it called experimental event rate (EER). In our example, the risk of death with diet is CER = 40/100 = 0.4 or 40% while the risk of death with gastric band EER = 30/100 = 0.3 or 30% ER=number of events/total number of the group (1) 3. Risk Difference (RD) One way of comparing two risks is by calculating the absolute difference between them. We refer to this as risk difference (RD) or as the absolute risk reduction (ARR). The formula for calculating the RD is: RD=|ER-EER| (2) The symbol | | was used to indicate that this parameter uses absolute rather than relative terms in looking at the proportion of patients who are spared from the adverse outcome. In our example, the RD is 0.4 − 0.0.3 = 0.1. That means a RD of 10%. In this case there is a reduction of 10% which is also called absolute risk reduction (ARR). Let us assume that the intervention (gastric band surgery) caused increase in mortality and made it 60% (the base line was 40%). In this case RD = |CER − EER| = |0.4 − 0.6| = |0.2| = 20% increase in risk or what is called absolute risk increase (ARI). It might be easier for clinicians to avoid the terms ARR and ARI and only stick to RD as it will be able to express both conditions.

P-105: Cardiovascular and muscular fitness in morbidly obese adolescents after gastric band surgery

Fitness is a potentially modifiable variable that impacts disease expression in obese individuals. There is little known about the cardiovascular and muscular fitness of morbidly obese adolescents seeking bariatric surgery and the changes in fitness after surgery.

PL-224: Short-term changes in metabolic syndrome risk factors following gastric band surgery in adolescents

PL-224: Short-term changes in metabolic syndrome risk factors following gastric band surgery in adolescents

Venous Thromboembolism Complicating Adjustable Gastric Band Surgery Performed in Bariatric Surgery Centers of Excellence (BSCOE): Analysis of Bariatric Outcomes Longitudinal Database TM (BOLD TM)

Venous Thromboembolism Complicating Adjustable Gastric Band Surgery Performed in Bariatric Surgery Centers of Excellence (BSCOE): Analysis of Bariatric Outcomes Longitudinal Database TM (BOLD TM)

Pregnancy and Fertility Following Bariatric Surgery: A Systematic Review

Context Use of bariatric surgery has increased dramatically during the past 10 years, particularly among women of reproductive age. Objectives To estimate bariatric surgery rates among women aged 18 to 45 years and to assess the published literature on pregnancy outcomes and fertility after surgery. Evidence Acquisition Search of the Nationwide Inpatient Sample (1998-2005) and multiple electronic databases (Medline, EMBASE, Controlled Clinical Trials Register Database, and the Cochrane Database of Reviews of Effectiveness) to identify articles published between 1985 and February 2008 on bariatric surgery among women of reproductive age. Search terms included bariatric procedures, fertility, contraception, pregnancy, and nutritional deficiencies. Information was abstracted about study design, fertility, and nutritional, neonatal, and pregnancy outcomes after surgery. Evidence Synthesis Of 260 screened articles, 75 were included. Women aged 18 to 45 years accounted for 49% of all patients undergoing bariatric surgery (>50 000 cases annually for the 3 most recent years). Three matched cohort studies showed lower maternal complication rates after bariatric surgery than in obese women without bariatric surgery, or rates approaching those of nonobese controls. In 1 matched cohort study that compared maternal complication rates in women after laparoscopic adjustable gastric band surgery with obese women without surgery, rates of gestational diabetes (0% vs 22.1%, P Conclusion Rates of many adverse maternal and neonatal outcomes may be lower in women who become pregnant after having had bariatric surgery compared with rates in pregnant women who are obese; however, further data are needed from rigorously designed studies.

Laparoscopic revision of gastric band surgery

To identify the outcome of laparoscopic revision of gastric band surgery with respect to percentage of excess weight lost (%EWL). Analysis of a prospective database was then performed and %EWL was plotted with respect to time from initial procedure and also time from revision procedure. All revision operations were performed laparoscopically. There were no patient deaths, but two serious complications. Percentage excess weight loss after replacement of the band because of prosthetic failure or dysphagia was 57% at an average follow-up of 19 months. For repositioning of the band due to slippage, the %EWL was 72% at an average of 15 months follow-up for those who had the existing band repositioned, and 42% at an average of 23 months follow-up for those who had a new band repositioned. Revision laparoscopic gastric band surgery is a safe option for patients, and results in good %EWL at an average follow-up period of 19 months.