Functional Abdominal Pain Syndrome in Morbidly Obese Patients Following Laparoscopic Gastric Bypass Surgery

Background: Roux-en-Y gastric bypass surgery (RYGBP) is one of the most common bariatric surgeries, which is being performed using various techniques like gastrojejunostomy by hand swen, linear or circular stapler. Abdominal pain is a common complaint following laparoscopic gastric bypass procedure (LGBP), which has different aetiologies, such as overeating, adhesion, internal herniation, bile reflux and many more. In this study LGBP was performed in an ante-colic ante-gastric pattern in a double loop manner and the prevalence and distribution of pain in morbidly obese patients undergoing LGBP was assessed. Objectives: The aim of this study was to analyze the distribution and frequency of post LGBP pain in morbidly obese patients. Patients and Methods: This study was performed on 190 morbidly obese patients referred to Hazrat Rasoul Hospital in Tehran. After LGBP, pain was measured in the following intervals: 24 hours, one week and one month after the operation. Before the operation onset, 2 mg Keflin and 5000 IU subcutaneous heparin were administered as prophylaxis. LGBP was performed using five ports including: one 11 mm port was placed 15-20 cm far from the xiphoid, one 12-mm port in mid-clavicular line at the level of camera port, one 5-mm port in subcostal area in ante-axillary region in the left, another 5-mm port in the right mid-clavicular area and a 5-mm port in sub-xyphoid. All operations were done by the same team. Staple was used for all anastomoses and hand sewn technique to close the staple insertion site. The mesenteric defect was left open and no effort was made to repair it. Results: The results of this study showed that 99.94 % of the patients had complains of pain in the first 24 hours of post operation, about 60% after one week and 29.5 % still had pain after one month. In addition, left upper quadrant (LUQ) was found to be the most prevalent site for the pain in 53.7% of the patients in the first 24 hours, 59.6% after one week and 16.8% after one month (except for obscure pain) with a significance of < 0.05. Conclusions: In this study, the authors analyzed the location and disturbance level of pain after LGBP, which could serve as a cornerstone for further researches. The authors suggest that long-term follow-up (for more than a year after operation) should be considered in future studies and also the relationship between the drainage site and pain should be investigated

Short-term outcomes of the conversion of one anastomosis gastric bypass to Roux-en-Y gastric bypass in symptomatic reflux patients without revising the size of the gastric pouch

Background: Revising the size of the gastric pouch during the conversion of one anastomosis gastric bypass (OAGB)/mini-gastric bypass to Roux-en-Y gastric bypass (RYGB) is an important point. Even in patients undergoing RYGB, marginal ulcer is regarded as a known complication. Materials and Methods: In our Centre of Excellence in Bariatric and Metabolic Surgery, 2492 patients underwent OAGB from February 2012 to January 2019. Twelve of 2492 patients were enrolled in this clinical case series because of persistent gastroesophageal reflux-like symptoms which underwent conversional RYGB. All patients regularly received proton-pump inhibitors (PPIs) for 6 months after the surgery. After this period, the cases with symptomatic reflux were invited to be visited in the clinic by a bariatric surgeon and a gastroenterologist and received 6 months of PPI therapy until their symptoms disappeared. Twelve refractory reflux cases underwent conversional RYGB after 1 year. An enteroenterostomy was created in all the patients 75 cm distal to the gastrojejunostomy without resizing the gastric pouch, and the jejunal loop was cut just before the gastrojejunostomy. Results: Before conversional surgery, mean ± standard deviation (SD) body mass index (BMI) and gastroesophageal reflux disease (GERD)-Q score were found to be 26.45 ± 2.34 kg/m2and 10.08 ± 0.56, respectively. At 1 year after conversion, mean ± SD BMI in the patients was 28.12 ± 4.71, and GERD-Q score was 5.08 ± 1.5. Conclusion: It seems that resizing the gastric pouch is not necessary during the conversion of OAGB to RYGB. © 2021 Wolters Kluwer Medknow Publications. All rights reserved

Pre-operative rectal indomethacin for reduction of postoperative nausea and vomiting after laparoscopic cholecystectomy: a double-blind randomized clinical trial

OBJECTIVE: To evaluate the effect of pre-operative indomethacin suppository on postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. STUDY DESIGN: A double blind placebo-controlled randomized clinical trial. PLACE AND DURATION OF STUDY: Hazrat Rasoul Akram Hospital, Tehran, Iran, from February 2010 to September 2012. METHODOLOGY: One hundred and thirty patients, scheduled for laparoscopic cholecystectomy, were randomly divided into case and control groups. Sixty-five patients received indomethacin suppository and 70 patients received rectal placebo in the case and control groups respectively. All patients underwent the same protocol in laparoscopic surgery and anesthesia, then nausea and vomiting was recorded after 1, 6, 12 and 24 hours postoperatively and compared between the two groups. Independent-sample t test or Mann-Whitney tests were used for statistical analysis. Level of statistical significance was set at P ² 0.05. RESULTS: Patients' nausea was statistically lower in the case group at the 1st hour (43.1 vs. 92.9), 6th hour (20.0 vs. 68.6) and 12th hour (7.7 vs. 24.3) after surgery (for all periods, P < 0.001). Fewer patients in the case group experienced vomiting at the first (13.8 vs. 51.4) and 6th hour (0 vs. 20) after surgery (for both P < 0.001). The use of pethidine was also statistically less in the case group in the same hours after surgery (for all of them, P < 0.001). CONCLUSION: Rectal indomethacin before laparoscopic cholecystectomy led to lower postoperative nausea and vomiting

Breakfast habits, nutritional status and their relationship with academic performance in elementary school students of tehran, iran

Background. The aim of this study was to examine the breakfast habits, nutritional status and their relationship with academic performance in primary school students in Tehran, Iran. Method. In this cross-sectional study 829 primary school children were included. Child Body Mass Index (BMI) was calculated based on the objective measures of height and weight as well as adjusted for age and gender. Data on Breakfast habits and academic performance were collected by a valid checklist. For data analysis we used Chi-squared and Fisher�s exact test using SPSS software, version 11.5; statistical significance was assumed if p-value is below the 0.05 Results. The average breakfast consumption per week was 5.5 times (days) with a standard deviation of 2.9. Based on the results, 30.9 of participants did not consume full breakfast (six times or less) and 69.1 had a complete one. In terms of academic grade level, 88.4 of the participants were in a high level, 10.3 in appropriate conditions and only 1.3 of the respondents required more effort (inappropriate).There was no significant correlation between breakfast consumption and academic status (p=0.73), nutritional status of the participants according to the academic performance status Individuals showed no statistically significant relationship (P=0.9). Conclusion. Unlike previous studies, this study revealed no correlation between the academic grade level of elementary students with nutritional status and breakfast habits. It is suggested that according to the qualitative school scoring method, future studies are needed to assessing the students�academic performance. Other parameters will be considered in addition to the average in order to provide a better perspective of students� academic performance. © 2019 Universitatea de Medicina si Farmacie Iuliu Hatieganu. All rights reserved

Changes in gut microbial flora after Roux-en-Y gastric bypass and sleeve gastrectomy and their effects on post-operative weight loss

Bariatric surgery affects gut microbial flora due to the anatomical and physiological changes it causes in the gastrointestinal tract. Understanding the interaction between the gut flora, the type of bariatric surgery and weight loss may help improve bariatric surgery outcomes. This study was designed to compare the effects of Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) on two main phyla of the gut microbiota in humans and evaluate their potential effect on weight changes. Thirty morbidly obese patients were divided into two groups and underwent laparoscopic SG or laparoscopic RYGB. The patients� weight changes and fecal samples were evaluated at baseline and 6 months after the surgery. A microbial flora count was carried out of the phyla Bacteroidetes and Firmicutes and Bacteroides Fragilis. Changes in the abundance of the flora and their correlation with weight loss were analyzed. After 6 months, the patients with a history of RYGB showed a significant decrease in stool Bacteroidetes while the reduction in the SG group was insignificant. Firmicutes abundance was almost unchanged following SG and RYGB. There was no significant change in Bacteroides Fragilis abundance in either of the two groups, but a positive correlation was observed between Bacteroides Fragilis and weight loss after SG and RYGB. Bariatric surgery can affect gut microbiota. It can be concluded that these changes are dependent on many factors and may play a role in weight loss. © 2020, Italian Society of Surgery (SIC)

A comparison of maladaptive early schemas and appearance schemas in obese and normal weight control subjects

The purpose of this study was to compare early maladaptive and appearance schemas in obse and and normal-weight subjects. Materials and Methods: The method of the study was causal- comparative and groups were included 30 obese (BMI�35) and 30 normal-weight adults (BMI<25). All participants completed Young Schema Questionnaire�Short Version (YSQ-S) and appearance schema Inventory (ASI) questionnaire. Results: Obse subjects showed significantly higher scores in compare to control group in self-sacrifice and emotional inhibition schemas. In addition, severity of appearance schemas in body- image vulnerability and self- investment subscales were significantly greater in obese subjects than in control group. Conclusion: The results of this study suggest that some early maladaptive and appearance schemas are associated with obesity and therefore, theoretical conceptualizations and psychological interventions should address the above thesis constructs. © 2015, Semnan University of Medical Sciences. All rights reserved

Configuring a better estimation of kidney size in obese children and adolescents

Background: Obesity ignites numerous health and psychosocial problems and is associated with various comorbidities. Body mass index (BMI) is also independently associated with improved risk for numerous kidney disorders. As renal length is considered a vital parameter in the clinical assessment of renal patients, normal renal length has to be defined in accordance to BMI. Objectives: The aim of this study was to define normal kidney length in obese children, comparing ultrasound measurements of the kidney length in obese and non-obese children and adolescents, in order to reduce unnecessary evaluations for nephromegaly. Patients and Methods: Fifty obese children and adolescents and 50 non-obese children and adolescents, aged 1-19 years, were selected from patients of pediatric clinics in two hospitals (Rasoul-e-Akram and Shahid Fahmideh) in Tehran between June 2010 and 2012. After the nephrologist�s and endocrinologist�s approval, the largest longitudinal renal dimension was measured in deep inspiration position by abdomino-pelvic ultrasonography in both groups. Results: It was revealed that both kidneys in obese group were significantly larger than in control group (P = 0.044 and 0.040, respectively). Obesity status, height and age were proven to be significant and independent predictors of length of both kidneys. In both groups length of left kidney was significantly larger than that of right kidney (P < 0.001). Conclusions: A specific standard cut-point limit or norm gram has to be formulated for obese children and adolescents in order to facilitate the diagnosis of kidney diseases, including organomegaly, in these patients. © 2016, Growth & Development Research Center

Comparing the excessive daytime sleepiness of obese and non-obese patients

Background: Obesity, particularly morbid obesity, has various physical and mental complications. Excessive daytime somnolence (EDS) is a sleep disorder that reduces individuals� performance capability and the accuracy of their short-term memory and causes learning problems. This retrospective study aimed to document the presence of EDS in a sample of obese patients in comparison to patients with a normal weight. Objectives: This article compares the excessive daytime sleepiness of obese and non-obese patients in the minimally invasive surgery research center in Tehran, Iran. Patients and Methods: In this case-control study, we compared excessive daytime sleepiness in 55 obese patients who were candidates for laparoscopic surgery, with a body mass index (BMI) of equal to or greater than 30 kg/m2, with 55 controls with a normal BMI (19.5-24.9 kg/m2). The process of selecting the control group in our case-control study is matching in group levels, so that the controls are similar to the case group with regard to certain key characteristics, such as age, sex, and race. The sleep assessment was based on the Epworth sleepiness scale (ESS) questionnaire. Analysis of variance (ANOVA) was used to compare the means of quantitative data, such as the ESS score of groups. Results: Sleepiness was not affected by gender in cases or controls. The sleepiness prevalence was 29 (52.7) in the cases group and 17 (30.9) in the control group (OR = 2.493 (95 CI 1.144-5.435)). The mean ESS scores in cases and controls were 7.82 ± 3.86 and 10.54±6.15, respectively (P = 0.007). Moreover, the prevalence of sleepiness and the mean ESS scores in class III of obesity differed significantly from the controls (16 (57.1) vs. 17 (30.9)) (OR = 2.980 (95 CI 1.162-7.645)) and (11.04±5.93 vs. 7.82±3.86) (P = 0.013), respectively. Conclusions: Our findings suggest a strong relationship between EDS and obesity, particularly morbid obesity. Therefore, physicians must be familiar with EDS as a mixed clinical entity indicating careful assessment and specific treatment planning. © 2016, Iranian Red Crescent Medical Journal

The prevalence of zinc deficiency in morbidly obese patients before and after different types of bariatric surgery

Background: The prevalence of obesity is considered to be increased worldwide. Lack of mineral elements is one of the essential side effects of bariatric surgery as a trending treatment for obesity. We aimed to assess zinc deficiency among morbidly obese patients before and following different types of bariatric surgical procedures. Methods: In the present retrospective cohort study, 413 morbidly obese patients (body mass index (BMI) � 40 kg/m2 or BMI � 35 kg/m2 with a complication or risk factor, e.g., diabetes mellitus) were enrolled who received bariatric surgery, aged between 18 and 65 years old, and had a negative history of active consumption of alcohol and illicit drugs. Patients were assigned into three groups of bariatric surgeries: mini-gastric bypass, Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG). We recorded baseline clinical and demographic characteristics and zinc serum levels during the preoperative and postoperative follow-up periods at three, six, and 12 months after the operation. Results: All patients with a mean age of 40.57 ± 10.63 years and a mean preoperative BMI of 45.78 ± 6.02 kg/m2 underwent bariatric surgery. 10.2 of the bariatric patients experienced zinc deficiency before the surgery, and 27.1 at 1 year after the surgery. The results showed that 27.7 of mini-gastric bypass patients, 29.8 of RYGB, and 13.3 of SG experienced zinc deficiency 12 months following surgery. We observed no statistical differences in the preoperative and postoperative zinc deficiency between different types of surgeries. Conclusion: A high prevalence of preoperative zinc deficiency among morbidly obese patients who underwent bariatric surgery was observed, which increased during the postoperative periods. We recommend assessing zinc serum levels and prescribing zinc supplements before the bariatric operation to alleviate the prevalence of zinc deficiency after the operation. © 2021, The Author(s)

Omentoplasty in Deep Sternal Wound Infection

Background: The aim of this study was to evaluate retrospectively the results of reconstructing infected post-sternotomy incisions with pedicled omentoplasty. Methods: Between March 2009 and December 2012, 15 females (37.5) and 25 males (62.5) with an average age of 63 y (range 51-72 y) who were suffering from deep sternal wound infection (DSWI) after coronary artery bypass grafting underwent reconstructive surgery. We evaluated their pre-operative characteristics and post-operative courses. Results: Thirty-four of the patients (85) were found to have DSWI within 1 mo of their cardiac surgery. The mean operative time for the omental flap (OF) procedure was 90±16.8 min (range 70-135 min). There were three intra-operative complications (7.5), and post-operative complications occurred in 10 patients (25). No patient developed any sign of OF necrosis. The median lengths of the post-operative intensive care unit (ICU) and hospital stays were 4 d (range 1-6 d) and 7 d (range 5-14 d), respectively. At the time of discharge, all patients had normal cardiac and mental status. Conclusion: We obtained satisfactory outcomes when treating the patients with DSWI by a single-stage OF transposition. On the basis of our experience, we recommend this procedure as an option for patients with DSWI, especially those who are not in a severe low cardiac output state or malnourished. © Copyright 2015, Mary Ann Liebert, Inc