Incidence of venous thromboembolism in laparoscopic bariatric surgery : preliminary report

Background: Laparoscopic bariatric surgery, due to short operative duration and early ambulation of the patients, has reduced the incidence of postoperative venous thromboembolism (VTE) in morbidly obese patients.We evaluated the incidence of VTE in laparoscopic gastric banding for morbid obesity, and determined the optimal duration of heparin prophylaxis comparing two different regimens of low molecular weight heparin (LMWH). Methods: Since December 2002, two groups of patients, both males and females, underwent laparoscopic gastric banding for morbid obesity. Both groups were treated with LMWH 4,000 U/day, for different periods of time. Group A (49 patients, mean age: 38 years, mean BMI: 41.8) was treated until hospital discharge (3-4 days). Group B (38 patients, mean age: 37 years,, mean BMI 42.3) was treated for 10 days postoperatively. All patients wore elastic compression stockings and were early ambulant. The incidence of VTE was assessed by means of a standardized Color Doppler, performed before the operation, at the 3rd and 10th postoperative day, and a clinical check after 1 and 3 months. Results: Neither deep vein thrombosis nor pulmonary embolism were observed in either groups. In Group A, after suspension of LMWH, superficial thrombophlebitis occurred in 2 patients, who had saphenous reflux, which required readministration of LMWH. Conclusion: This preliminary report shows that the incidence of venous thromboembolism is low in laparoscopic gastric banding. The occurence of 2 superficial thromboses suggests, however, the need for a longer heparin prophylaxi

Ultrasonographic evaluation of the cervical lymph nodes in preoperative staging of esophageal neoplasms

Background: The detection of cervical lymph node metastases plays an important role in staging of patients affected by esophageal cancer to perform the best therapeutic approach.Methods: We report our experience concerning the ultrasound evaluation of the cervical area in 174 patients with esophageal cancer. Ultrasonographic evaluation of the neck can be done with a 7.5- or 10 MHz transducer in all cases, with selective scanning of the lymph node chains of the internal jugular veins and supraclavicular regions. The short-to-long axis ratio (S/L) was a useful way to detect lymph node metastasis. Histopathologic diagnoses were obtained by sonographically guided fine-needle aspiration biopsy.Results: At ultrasound examination, we found 18 (10.3%) patients with metastatic cervical nodes. Of these, 17 (94.4%) had metastatic cervical lymph nodes confirmed by cytology from fine-needle biopsy. Lymph node exceeding 5 mm in long axis and with an S/L over 0.5 showed a higher incidence of metastasis than those with an S/L under 0.5. Our experience shows a high incidence of lymph node metastases in patients with esophageal cancer localized to the thoracic supracarinal tract and in patients with cervical and lower esophageal cancer.Conclusion: In the ultrasound evaluation of nodes, the most useful parameters are size of nodes, heterogeneity of internal echoes, morphology of the margins, and the deformation caused by compressive instrumental manipulation. These criteria, indicated by the Japanese Society for Esophageal Diseases, yield a high sensitivity and diagnostic specificity when the ultrasonographic studies are performe

Intragastric balloon (BIB): 5-years experience

Background: Since 1998, we have used the BioEnterics Intragastric Balloon (BIB\u2122) in association with restricted diet for the treatment of obesity and morbid obesity. Methods: 474 BIB were placed in 418 obese and morbidly obese patients; 103 patients were male and 315 female; mean age was 41.5 (18-71.6) years; mean weight was 116.9 (67-265) kg; mean BMI was 42.02 (25.10-81.13) kg/m2; mean excess weight was 49.1 (4.2-179.7) kg corresponding to mean 65.5 (6.8- 247.8) % of the ideal weight. 53 patients had two balloons, 3 patients underwent three balloon insertions. The patients were given a balanced diet of 1,000 kcal/day with the temporary addition of omeprazole, vitamins and oligoelements. The duration of the treatment at the beginning of our experience was four months, but later six months. Results: After balloon-therapy, the mean weight loss was 13.9 (2-57) kg; the mean reduction in BMI was 4.74 (0.3-10.98) kg/m2. In 45 patients (9.49%), we had to remove the BIB early for vomiting. There was a rate of 4% of spontaneous deflation and/or fecal expulsion. Conclusion: The BIB is a valid method as preparatory treatment of morbidly obese patients before bariatric surgery in order to reduce operative risk; the results are comparable to those obtained with restricted diet only but in less time and with an acceptable risk of complication