Surgery In Candidates Research Articles

Inadequate Protein Intake Before and After Different Types of Bariatric Surgery: Systematic Review

Bariatric surgery is considered the most effective treatment for morbid obesity. Despite the successful weight loss, as result of bariatric surgery, patients are susceptible to protein deficiency. Change in food intake after surgery can cause some nutritional deficiencies. The aim of this study was to determine the status of protein before and after bariatric surgery Methods: The systematic search was performed in April 2021. Cochrane, PubMed, and google scholar databases were used for our literature search by searching these keywords: body composition, fat free mass, bariatric surgery, protein malnutrition and protein intake. Results: Our studies showed few evaluation of protein has been done before surgery in candidates for surgery. Obesity surgery reduces muscle mass and serum protein so evaluation of these factors is necessary. Bariatric surgery method exposes people to protein malnutrition and changes in body composition therefore more attention to their protein intake needs to be done. Conclusion: Based on our results dietary intake can affect the outcome of surgery, so, we recommended evaluating protein status and lean body mass before and following the bariatric surgery. Also, the effect of different types of protein supplementation to improve body composition can be assessed in further studies.

Quality of Life After Surgery in Candidates of Laparoscopic and Open Cholecystectomy: A Comparison Study

Background: Nowadays quality of life (QOL) is an important part of health and measuring health-related QOL after surgery is necessary for decision-making by patients and surgeons. To assess post cholecystectomy QOL, documentation of high quality care has been subjected to extended discussions, and the use of patient-reported outcome satisfaction for quality improvement has been advocated for several years. Objectives: The aim of this study was to compare quality of life after surgery in candidates of laparoscopic and open cholecystectomy. Patients and Methods: This study was an optional part of a longitudinal study for comparison of quality of life in candidates of laparoscopic (LC) and open cholecystectomy (OC). One hundred consecutive cases of hospitalized patients, aged 20 to 65 years, at two hospitals of Karaj, Iran (Imam Khomeini and Alborz), were recruited in the study from May to December 2011. Patients were divided to two groups based on the order of admission and the surgeons’ and patients’ preference. Patients were evaluated with the medical outcomes study 36-item short-form health survey (SF-36). Quality of life was measured at three points of time (the baseline was two and four weeks after surgery) using this health questionnaire. Differences between baseline time periods of two and four weeks were compared by independent-samples t-test and within groups the time periods were compared by the paired-sample t-test. Results: Two weeks after the operation, in the LC group, the QOL scores decreased significantly in physical functioning, physical status, body pain and emotional status (for all of them P ≤ 0.01), whereas, in the OC group all the aspect of QOL decreased (for all of them P < 0.01), with the exception of body pain (P = 0.982) and social functioning (P = 0.502). Four weeks after the operation, the QOL scores of the LC group, in every aspect increased and became significantly higher than the preoperative baseline (P < 0.001 for all parameters); while in the OC group only in the aspects of body pain (P < 0.001), general health (P = 0.003), and social functioning (P < 0.001) exceeded the preoperative level. Between-group analysis indicated that the LC group had significantly better outcome scores after four weeks compared to the OC group, in all aspects (P < 0.05 for all of them) with the exception of general health (P = 0.052). The results of the repeated measures analysis showed that there was a significant difference between the two groups during the three follow-up periods in the aspect of physical status (P = 0.008), vitality (P = 0.015), general health (P = 0.048) and emotional status (P = 0.003). Conclusions: Quality of life is an important factor affecting medical and surgical treatment, as well as decision-making. Improvement of short-term quality of life after laparoscopic cholecystectomy in comparison to open cholecystectomy proves the obvious superiority of LC over OC.

Virtual implantation and patient-specific simulation for optimization of outcomes in ventricular assist device recipients

BackgroundLeft ventricular assist devices (LVAD) are increasingly used for long-term mechanical circulatory support and are effective in improving survival and quality-of-life of patient with advanced heart failure. Nonetheless, they are associated with significant early and late morbidity rates (including pump thrombosis, thromboembolic events, and pump dysfunction). These complications are at least partially associated with suboptimal pump positioning. Currently, we are missing tools to further improve the positioning of LVAD devices in a patient-specific fashion. Methods and evaluation of the hypothesisWe hypothesized that the analysis of the implanted device in patients presenting selected LVAD-related complications through segmentation and three-dimensional reconstruction of CT scans may provide patient-specific information into mechanical factors contributing to pump dysfunction and thromboembolic events, with potential to guide preventive interventions against development of new complications. We also hypothesized that preoperative virtual implantation and computer-assisted surgery in candidates to LVAD implantation may help in the customization of device positioning, with potential to minimize severe complications. The hypothesis was evaluated in a multidisciplinary fashion (cardiac surgeons, biomedical engineers and biomedical images processing experts). CT scans of 14 LVAD recipients were reconstructed through semi-automatic segmentation (including the whole heart, the implanted device and the chest wall). A coordinate system was built to quantify the coaxiality of the LVAD apical cannula with the mitral annulus. Patients were stratified into Group 1 (presenting complications such as thromboembolic events, pump dysfunction or thrombosis) and Group 2 (no complications). Group 1 patients presented significantly greater average rotation of the apical cannula towards the interventricular septum (p=0.015), although no difference was observed in terms of average rotation towards the anterior or posterior left ventricular wall. ConclusionsSeveral patient-specific factors (including left ventricular morphology and chest wall conflict with the device after wound closure) may influence the effectiveness and safety of LVAD therapy, but they are difficultly managed through the current implantation techniques. We suggest that the clinical results of LVAD treatment can be improved through preoperative virtual implantation and computer-assisted surgery (in order to guide device selection, exact site of left ventricular wall coring site). Given these preliminary results, we are examining larger patient datasets in order to further test the hypothesis. Dedicated tools for virtual implantation are currently under development.