Preoperative insurance status influences postoperative complication rates for gastric bypass

Article Abstract:

Stomach-stapling surgery to restrict intake of food is an accepted procedure to help morbidly obese patients (those at least 100 pounds overweight) lose weight. This procedure has a low death rate and is effective; however, there is a high complication rate within the first six months. A study of 100 morbidly obese patients was undertaken to determine how various factors affect complication rate, weight loss and reduction of associated illnesses. There were 42 patients who developed at least one complication during follow-up, which ranged from one to five years. There were 23 medical complications, nine psychiatric, and 24 eating problems. No significant relationship was found between outcome and age, sex, age of obesity onset, or other medical problems. The 40 patients receiving publicly funded health insurance (medical assistance, Social Security disability, or workmen's compensation) developed significantly more medical and psychiatric complications than did the 60 patients with private medical insurance. During the first year both groups had similar weight loss, measured in number of pounds and percent of weight reduction. Patients in both groups had reductions in medication required to treat diabetes mellitus, hypertension, and degenerative joint disease (all conditions influenced by obesity). Forty-five percent of the patients receiving public assistance prior to surgery were able to work full or part time, thus reducing their level of public support. Of the women with private insurance who had previously not been working outside the home, 46 percent were able to get part- or full-time jobs after the surgery. These results suggest that patients receiving public funding are at greater risk than those having private insurance for the development of complications following gastric stapling surgery, and they are also likely to benefit significantly by medication reduction and to decrease their level of public support following treatment. This study points out that socioeconomic status and other conditions associated with poverty are important and need to be included in any analysis of operative risk and outcome of obesity treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Overweight persons, Obesity, Insurance, Stomach

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Role of highly selective vagotomy and duodenoplasty in the treatment of postbulbar duodenal obstruction

Article Abstract:

Highly selective vagotomy is the cutting of selected branches of the vagus nerve in order to reduce the amount of gastric (stomach) acid secreted. This procedure is performed to treat chronic duodenal ulcer disease which has not responded to medical treatment; the duodenum is the first portion of the small intestine. Use of highly selective vagotomy has been expanded to treat complications of duodenal ulcers, but its use in cases of duodenal obstruction is controversial. The authors report their experience in treating 15 patients with postbulbar stenosis (narrowing below the level of the first portion of the duodenum) by performing highly selective vagotomy and duodenoplasty. The average age of the patients was 48 years, and all had a history of duodenal ulcer disease, averaging a duration of eight years. Vomiting, nausea and weight loss were symptoms reported by most patients. All patients underwent selective vagotomy, and 14 of 15 also had duodenoplasty to correct the narrowing of the duodenum. Two patients were lost to follow-up after they had normal results in postoperative examinations. The remaining 13 patients have been followed, and 12 have had excellent or good results. Twelve patients have undergone yearly postoperative evaluation; endoscopy was performed on 11 patients, and one patient had radiography. It is concluded that highly selective vagotomy and duodenoplasty should be considered when the anatomical location of the abnormality is appropriate for this treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Duodenal ulcer, Duodenum

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Postoperative gastric atony after vagotomy for obstructing peptic ulcer

Article Abstract:

This paper explores symptomatic improvement in patients with an obstructing ulcer of the stomach after cutting the Vagus nerve, the nerve which is involved in normal secretion and motility of the stomach. A frequent but temporary complication of this surgery is loss of muscle tone in the stomach. Six of 71 patients who had the Vagus cut at its trunk and only one of 30 patients who had the Vagus cut higher experienced a temporary period of gastric atony. (During a three year follow-up study, no significant differences arose in the quality of the surgery, which was judged to be good to excellent in most cases.) The authors conclude that gastric atony is a frequent complication of cutting the Vagus nerve, and that cutting the nerve above the trunk may reduce, but probably not eliminate a period of gastric atony.

Analysis, Ulcers, Intestines, Muscles, Muscle tone, Peptic ulcer, Intestinal obstruction, Ulcer surgery

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