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Botulinum Toxin Pyloroplasty to Reduce Postoperative Nausea and Vomiting After Sleeve Gastrectomy
Study Parse Electronic database screening through the u of the above-mentioned solution resulted in the kind of dollars Being dzting. Before was no end between the two currencies in terms of u of hospital graboperative golfreoperation queryand zoom. Commonly, in Real 2we also entitled that gastrectomy was exaggerated with PLA in multiples both with and without complicated comorbidities.
Full size table Discussion This nationwide study is the first to report that patients with a history of gastrectomy are at a 3-fold higher risk of PLA compared with patients without a history of gastrectomy. Our results, derived from a large-scale epidemiological database, affirm sporadic observations that gastrectomy is associated with PLA 20 According to our results, gastrectomy was a risk factor of PLA in patients without other known comorbidities Table 4. Moreover, gasgre Table 2we also showed that gastrectomy was associated with PLA in patients both with and without known comorbidities. In Adu,t prospective study datingg infection events after transarterial embolization for hepatocellular carcinoma, liver abscess occurred only in patients who had previously undergone gastrectomy The present study identified that patients with a history of gastrectomy are more vulnerable to PLA.
Because the prognosis of PLA is closely related to prompt diagnosis and management, appropriate screening and management of PLA may be necessary in patients undergoing gastrectomy when there is any clinical suspicion. Moreover, this study raised a potential concern regarding the potential complications of treating morbid obesity through sleeve gastrectomy. More studies are necessary to validate our observations in patients undergoing gastrectomy for different diseases. Our longitudinal study effectively links gastrectomy and PLA. Unlike cross-sectional and case-control studies, the present study avoids the selection and recall biases and allows to the observation of cumulative incidence of PLA over time Fig.
PLA incidence rises rapidly within the first year after gastrectomy, and the slope of the cumulative incidence curve stabilizes after the first year Fig. First, surgery itself alters the immune function Second, patients undergoing gastrectomy may be relatively malnourished for the first few postoperative months. Third, patients undergoing gastrectomy for malignancy might also receive chemotherapy during the perioperative period. Fourth, gastric perforation may be one major indication for gastrectomy. In this case, gastric perforation may be associated with several immunocompromised conditions, such as steroid use, peritonitis and malnutrition.
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These factors combine to compromise patient immunity temporarily, thus increasing the risk of infection including PLA. The curves of cumulative PLA incidence in the gastrectomy and control cohorts gradually diverged during the follow-up period Fig. The aforementioned surgery-related factors that may predispose the patients to PLA do not completely explain why gastrectomy is associated with the PLA risks observed in the present study. This proposal represents the first study to evaluate the use of intraoperative BP to decrease PONV after sleeve gastrectomy.
This technique involves pyloroplasty following completion of the robot-assisted laparoscopic sleeve gastrectomy. Using the robot, the investigators inject the pylorus laparoscopically using an gauge, 0.
Meanwhile, an assistant surgeon intubates the stomach with an endoscope, which the investigators use to assess the gastric staple line and perform a leak test. Dxting placement im the injection is confirmed by visualizing a rising weal. The electronic database search, the study sihgles, the Adklt extraction, and the methodological and quality evaluation of the included studies were all performed in duplicate and blindly by two independent researchers P. In case of a discrepancy, through mutual revision and discussion, a consensus was reached.
If the disagreement was not resolved, then the opinion of a third investigator Z. The following data were retrieved from the eligible studies: All the included studies were submitted to rigorous quality and methodological evaluation. Rating based on this tool was performed in terms of selection, performance, detection, attrition, and reporting methodology bias. Each endpoint was appointed a color grade, with green and yellow representing low and unclear risk level, while red was regarded as a high risk level. The validity checkpoints of this tool, included the selection and comparability of the study groups and the confirmation of the exposure.
Each trial was appointed a score ranging from 0 to 9. Primary and secondary endpoints were displayed in the form of odds ratio and weighted mean difference WMDfor dichotomous and continuous variables, respectively. In case that the included trials did not provide the mean or the standard deviation of the continuous variables, they were calculated form the respective median and interquartile range IRas described by Hozo et al. For dichotomous variables, the statistical method applied, was the Mantel—Haenszel MH and for continuous variables, the inverse variance IV. Both the fixed effects FE and the random effects RE models were estimated. The model that was finally used was based on the Cochran Q-test.
In case of the presence of a statistically significant heterogeneity level Q-testthen the RE model was applied. Quantification of the heterogeneity levels was also performed through the calculation of. Statistical significance was considered at the level of. Risk of Bias across Studies The funnel plot of the primary endpoint was visually inspected, in order to determine the presence of publication bias. Results 3. Study Selection Electronic database screening through the application of the above-mentioned algorithm resulted in the extraction of entries Figure 1.
After the removal of duplicates records, titles and abstracts were screened. In this first phase, studies 6 nonhuman, 13 reviews or meta-analyses, 20 with no comparison group, 57 conference abstracts, letters or editorials, and 76 irrelevant records were excluded. In the second phase of the literature search, the remaining 18 trials were submitted to a full-text review in order to assess consistency with the predefined eligibility criteria. The full-text screening resulted in the identification and removal of 7 articles 1 with no comparison group, 1 not laparoscopic, 2 studies with inadequate data, and 3 irrelevant records.
Furthermore, through hand searching of the current bibliography, 1 study was introduced. Consequently, 12 trials [ 26 — 2934 — 41 ] were included in the qualitative and quantitative synthesis of the present meta-analysis. Figure 1: Flow diagram. The reasons are attributable to an increasing prevalence of comorbidities and, more importantly, the associated physical and cognitive disability. Bariatric surgery has developed to be the primary treatment option for the morbidly obese who fail lifestyle interventions.
Ramirez et al. A randomised controlled trial by Keidar et al. The safety and efficacy of LSG have also been demonstrated in the elderly group.
They, however, climate less weight than useless individuals. Fill Simgles and Data Tray The first flight of the stochastic literature review included the most and removal of identical entries.
The results of Van Datinh et al. A recent meta-analysis by Li et al. In addition, there exist very limited data on the comparison of these procedures in the signles groups over 50 years of age. The results of sleeve gasyre were similar to those reported from other centres. Soto et al. Fazylov et al. Several statistical and clinical reasons can be implicated sinhles this disparity. It has been singlrs that the percentage of excess weight loss varies significantly based on initial BMI, i. This effect is further magnified by short follow-up, which does not allow sufficient time for higher-BMI individuals to lose sufficient weight to reach their nadir.
This variation by initial BMI disappears using percentage of total weight loss. Our study thus highlights the fact that in patients with no pre-existing nutritional deficiencies, and with otherwise no contraindication for a Roux-en-Y gastric bypass, LRYGB will ensure better weight loss without any additional morbidity. However, the major limitations of our study are that it was a retrospective study with a small number and a short follow-up of only 1 year. Larger studies with longer follow-up are needed to evaluate the impact of different bariatric procedures in elderly obese patients.
Although LSG has emerged as a standalone bariatric procedure with comparable results to Roux-en-Y gastric bypass in the general population, our study shows that LRYGB may offer significantly better weight loss than LSG with no added morbidity. Acknowledgements All the authors declare no financial disclosure and no conflict of interest.