Abstract:
OBJECTIVE:To review the physiologic effects of carbon dioxide (CO2) pneumoperitoneum in the morbidly obese. SUMMARY BACKGROUND DATA:The number of laparoscopic bariatric operations performed in the United States has increased dramatically over the past several years. Laparoscopic bariatric surgery requires abdominal insufflation with CO2 and an increase in the intraabdominal pressure up to 15 mm Hg. Many studies have demonstrated the adverse consequences of pneumoperitoneum; however, few studies have examined the physiologic effects of pneumoperitoneum in the morbidly obese. METHODS:A MEDLINE search from 1994 to 2003 was performed using the key words morbid obesity, laparoscopy, bariatric surgery, pneumoperitoneum, and gastric bypass. The authors reviewed papers evaluating the physiologic effects of pneumoperitoneum in morbidly obese subjects undergoing laparoscopy. The topics examined included alteration in acid-base balance, hemodynamics, femoral venous flow, and hepatic, renal, and cardiorespiratory function. RESULTS:Physiologically, morbidly obese patients have a higher intraabdominal pressure at 2 to 3 times that of nonobese patients. The adverse consequences of pneumoperitoneum in morbidly obese patients are similar to those observed in nonobese patients. Laparoscopy in the obese can lead to systemic absorption of CO2 and increased requirements for CO2 elimination. The increased intraabdominal pressure enhances venous stasis, reduces intraoperative portal venous blood flow, decreases intraoperative urinary output, lowers respiratory compliance, increases airway pressure, and impairs cardiac function. Intraoperative management to minimize the adverse changes include appropriate ventilatory adjustments to avoid hypercapnia and acidosis, the use of sequential compression devices to minimizes venous stasis, and optimize intravascular volume to minimize the effects of increased intraabdominal pressure on renal and cardiac function. CONCLUSIONS:Morbidly obese patients undergoing laparoscopic bariatric surgery are at risk for intraoperative complications relating to the use of CO2 pneumoperitoneum. Surgeons performing laparoscopic bariatric surgery should understand the physiologic effects of CO2 pneumoperitoneum in the morbidly obese and make appropriate intraoperative adjustments to minimize the adverse changes.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Nguyen NT,Wolfe BMdoi
10.1097/01.sla.0000151791.93571.70subject
Has Abstractpub_date
2005-02-01 00:00:00pages
219-26issue
2eissn
0003-4932issn
1528-1140pii
00000658-200502000-00005journal_volume
241pub_type
杂志文章,评审abstract::The aim of this study was to determine the long-term outcome among 390 patients with ulcerative colitis who underwent ileal J pouch-anal anastomosis and whether patient or operative factors influenced results. The combined operative morbidity rate for the pouch-anal anastomosis and the subsequent closure of the tempor...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198710000-00011
更新日期:1987-10-01 00:00:00
abstract::Most patients with Marfan's syndrome have cardiovascular manifestations and complications of these abnormalities lead to death in 50% of patients by the age of 32. This report is concerned with the performance of 79 operations to control these problems in 41 patients during a 16-year period. There were 3 early deaths ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198310000-00009
更新日期:1983-10-01 00:00:00
abstract:OBJECTIVE:To assess existing measures of pathologic response to neoadjuvant therapy in esophageal and junctional cancer, and to recommend an optimum classification. BACKGROUND:Multimodal therapy is increasingly the standard of care for locally advanced esophageal cancer. Numerous measures of pathologic response have b...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182a66588
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVE:Comparison of minimal access retroperitoneal pancreatic necrosectomy (MARPN) versus open necrosectomy in the treatment of infected or nonresolving pancreatic necrosis. SUMMARY OF BACKGROUND DATA:Infected pancreatic necrosis may lead to progressive organ failure and death. Minimal access techniques have been ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181d96c53
更新日期:2010-05-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to assess the effect of cancer-related genes and their mutations analyzed by next-generation sequencing (NGS) on the oncological outcome after resection of colorectal liver metastases (CRLM). BACKGROUND:Traditional prognostic scores include clinical and pathological parameters of pr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003527
更新日期:2019-11-01 00:00:00
abstract::A technique for repairing benign hilar hepatic duct strictures using transhepatic intubation with a large bore silastic stent is described. This procedure has been used in 10 patients. In 9 instances the stricture involved the common hepatic duct, and in one patient the right and left hepatic ducts. Nine of the strict...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197605000-00005
更新日期:1976-05-01 00:00:00
abstract::Thirty-eight cases of carcinoma of the ampulla of Vater are presented. The diagnosis has been confirmed at laparatomy in all patients. Three operations were done, a pancreaticoduodenal resection in 23 patients, a biliary-enteric bypass in 7 patients and a biliary-enteric bypass plus excision of tumor in 8 patients. Th...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197604000-00002
更新日期:1976-04-01 00:00:00
abstract:OBJECTIVE:To determine whether the antibacterial properties of cultured composite keratinocyte grafts can be enhanced by cytokines that stimulate the innate immune response. SUMMARY BACKGROUND DATA:Use of composite grafts of cultured keratinocytes has been limited because of their susceptibility to burn wound microorg...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200201000-00015
更新日期:2002-01-01 00:00:00
abstract:OBJECTIVE:The aim of this study is to evaluate the oncological outcomes of robotic total mesorectal excision (TME) at an NCI designated cancer center. SUMMARY BACKGROUND DATA:The effectiveness of laparoscopic TME could not be established, but the robotic-assisted approach may hold some promise, with improved visualiza...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002112
更新日期:2018-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the potential of postischemic intravenous infusion of the endogenous antioxidant glutathione (GSH) to protect the liver from reperfusion injury following prolonged warm ischemia. BACKGROUND DATA:The release of reactive oxygen species (ROS) by activated Kupffer cells (KC) and leukocytes causes rep...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000110321.64275.95
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVE:Cancer patients are at a relatively high risk of venous thromboembolism (VTE), and this has implications for surgical outcome. DATA SOURCE:English literature search including the keywords cancer, surgery and VTE was undertaken to review the risk, etiology, prevention and treatment of VTE in surgical oncology...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318195c50c
更新日期:2009-03-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to compare patient outcomes between International Medical Graduate (IMG) versus US medical graduate (USMG) surgeons. SUMMARY BACKGROUND DATA:One in 7 surgeons practicing in the US graduated from a foreign medical school. However, it remains unknown whether patient outcomes differ be...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003736
更新日期:2019-12-10 00:00:00
abstract:BACKGROUND:Esophagectomy is a technically challenging procedure, associated with significant morbidity. The introduction of minimally invasive esophagectomy (MIE) has reduced postoperative morbidity. OBJECTIVE:Although the short-term effect on complications is increasingly being recognized, the impact on long-term sur...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003772
更新日期:2020-01-14 00:00:00
abstract::Records of 32 patients with 34 villous and tubulovillous adenomas of the duodenum, treated at the Cleveland Clinic over the past 21 years, were reviewed. Twenty-two patients (69%) had complete resection of the adenoma; the incidence of malignancy was 47%. Five patients underwent a Whipple procedure; 4 patients had seg...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198803000-00002
更新日期:1988-03-01 00:00:00
abstract::In the absence of a prospective randomized study of patients treated conservatively or with thymectomy, a computer-assisted retrospective matches study was devised. Of 563 patients treated for myasthenia gravis without thymoma up to 1965, 104 had thymectomy. With computer assistance, each surgical patient was matched ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197610000-00008
更新日期:1976-10-01 00:00:00
abstract::This is the first reported case of mumps hemorrhagic pancreatitis in a child, documented at operation, and by rising mumps titers and complicated by a pseudocyst. In severe cases when surgery is indicated, drainage of the lesser sac usually prevents pseudocyst formation. If a pseudocyst occurs, drainage is required to...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197407000-00012
更新日期:1974-07-01 00:00:00
abstract:OBJECTIVES:The authors determined the effect of complications on length of stay (LOS) in surgical patients. SETTING:From 1987 to 1990, in the Professional General Surgical Unit of Royal Victoria Hospital, a retrospective survey was conducted on 5128 consecutively admitted patients with 396 different diagnosis; 228 dif...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199412000-00006
更新日期:1994-12-01 00:00:00
abstract:OBJECTIVE:This study was aimed to investigate the prognostic value of tumor-infiltrating neutrophils (TINs) and to generate a predictive model to refine postoperative risk stratification system for patients with gastric cancer. BACKGROUND:TIN presents in various malignant tumors, but its clinical significance in gastr...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002058
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:This study determined how scar formation develops in a non-human primate model of fetal skin repair. SUMMARY BACKGROUND DATA:A transition from healing scarlessly to healing with scar formation characterizes skin repair in rat and sheep fetuses. New knowledge of the regulatory processes occurring in the fetal...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199304000-00011
更新日期:1993-04-01 00:00:00
abstract::The effects of pH on the tensile properties of eight commonly used 2-0 suture materials--plain catgut, Dexon, Vicryl, silk, Nurolon, Ethilon, Mersilene, and Prolene--were examined. The pH level ranged from 3.0 to 10.0. In general, absorbable suture materials were more sensitive to pH than non-absorbable suture materia...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198308000-00019
更新日期:1983-08-01 00:00:00
abstract:OBJECTIVE:Our goal was to describe contemporary management and in-hospital mortality associated with blunt thoracic aortic intimal tears (IT) within the American College of Surgeons Trauma Quality Improvement Program. SUMMARY BACKGROUND DATA:The evidence basis for nonoperative expectant management of traumatic IT of t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004415
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVE:To evaluate discrepancies between trial registry entries and final reports of randomized controlled trials (RCTs) published in major general surgical journals. BACKGROUND:Health care decisions are based on published results in peer-reviewed journals. Mandatory trial registration was introduced to increase tr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318283cf7f
更新日期:2013-06-01 00:00:00
abstract::Nasogastric (NG) decompression after colorectal surgery is practiced commonly. Our aim was to determine whether routine NG decompression benefitted patients undergoing this type of surgery. Five hundred thirty-five patients were randomized prospectively to either NG decompression or no decompression. Stratification wa...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-198906000-00003
更新日期:1989-06-01 00:00:00
abstract:OBJECTIVE:To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND:Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS:The...
journal_title:Annals of surgery
pub_type: 杂志文章,实务指引
doi:10.1097/SLA.0000000000003580
更新日期:2020-03-01 00:00:00
abstract:OBJECTIVE:To develop and validate a preoperative frailty index (pFI) for use in population-based health administrative (HA) data. SUMMARY BACKGROUND DATA:Frailty is a robust predictor of adverse postoperative outcomes. Population-level frailty measures used in surgical studies have significant methodological limitatio...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002769
更新日期:2019-07-01 00:00:00
abstract::Desmoid tumors are locally invasive, nonmetastasizing fibrous tumors most frequently seen in patients with familial polyposis coli (FPC). Of 325 patients with FPC treated at the Cleveland Clinic, 29 (8.9%) were found to have a total of 36 desmoid tumors. These tumors occur in young patients (mean age: 29.8 years), par...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198607000-00014
更新日期:1986-07-01 00:00:00
abstract:OBJECTIVE:To compare the accuracy of the modified Fried Index (mFI) and the Clinical Frailty Scale (CFS) to predict death or patient-reported new disability 90 days after major elective surgery. BACKGROUND:The association of frailty with patient-reported outcomes, and comparisons between preoperative frailty instrumen...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002967
更新日期:2020-02-01 00:00:00
abstract::A study of 103 cases of acute occlusion of the superior mesenteric artery is presented. The relation of site of occlusion to etiology, extent of infarction, and survival following resection and revascularization is described. Included is an analysis of the technical factors contributing to successful revascularization...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197812000-00003
更新日期:1978-12-01 00:00:00
abstract:OBJECTIVE:These studies were designed to elucidate the mechanism by which signals delivered by anti-CD2 monoclonal antibody (MoAb) interfere with activational signals delivered by anti-CD3 MoAb and induce long-term graft survival and tolerance. SUMMARY BACKGROUND DATA:Anti-CD2 or anti-CD3 MoAb can prolong allograft su...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199310000-00009
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVE:Currently single-incision laparoscopic appendectomy (SIL-A) has become an option for treating appendicitis. The aim of this study was to evaluate the safety and feasibility of SIL-A compared with conventional laparoscopic appendectomy (CL-A) on a large experimental cohort. BACKGROUND:Several studies had repo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001064
更新日期:2015-12-01 00:00:00