ABSTRACT: The magnitude of the systemic stress response is proportional to the degree of operative trauma. We hypothesized that laparoscopic gastric bypass (GBP) is associated with reduced operative trauma compared with open GBP, resulting in a lower systemic stress response.
Forty-eight patients with a body mass index of 40 to 60 were randomly assigned to laparoscopic (n = 26) or open (n = 22) GBP Blood samples were measured at baseline and at 1, 24, 48, and 72 hours postoperatively. Metabolic (insulin, glucose, epinephrine, norepinephrine, dopamine, ACTH, cortisol), acute phase (C-reactive protein), and cytokine (interleukin [IL]-6, IL-8, tumor necrosis factor [TNF]-alpha) responses were measured. Catabolic response was also measured by calculating the nitrogen balance at 24 and 48 hours postoperatively.
The two groups of patients were similar in terms of age, gender, and preoperative body mass index. The mean operative time was longer for laparoscopic GBP than for open GBP (229 +/- 50 versus 207 43 minutes). After laparoscopic and open GBP, plasma concentrations of insulin, glucose, epinephrine, dopamine, and cortisol increased; IL-8 and TNF-alpha remained unchanged; and negative nitrogen balances occurred at 24 and 48 hours. There was no significant difference in these parameters between groups. Concentrations of norepinephrine, ACTH, C-reactive protein, and IL-6 levels also increased, but these levels were significantly lower after laparoscopic GBP than after open GBP (p < 0.05).
Systemic stress response after laparoscopic GBP is similar to that after open GBP, except that concentrations of norepinephrine, ACTH, C-reactive protein, and IL-6 are lower after laparoscopic than after open GBP. These findings may suggest a lower degree of operative injury after laparoscopic GBP.
Journal of the American College of Surgeons 06/2002; 194(5):557-66; discussion 566-7. · 4.55 Impact Factor
ABSTRACT: Background: Intraoperative hypothermia is a common event during open and laparoscopic abdominal surgery. The aim of this study
was to compare changes in core temperature between laparoscopic and open gastric bypass (GBP). Methods: 101 patients with
a body mass index (BMI) of 40-60 kg/m2 were randomly assigned to open (n=50) or laparoscopic (n=51) GBP. Anesthetic technique was similar for both groups. An external
warming blanket and passive airway humidification were used intraoperatively. Core temperature was recorded at preanesthesia,
at baseline (after induction) and at 30-min intervals; intra-abdominal temperature was additionally measured at 30-min intervals
in a subset of 30 laparoscopic GBP patients.The number of patients who developed intraoperative and postoperative hypothermia
(<36°C) was recorded. Length of operation for both groups and the amount of CO2 gas delivered during laparoscopic operations were also recorded. Results: There was no significant difference between groups
with respect to age, gender, mean BMI, and amount of intravenous fluid administered. After induction of anesthesia, core temperature
significantly decreased in both groups; 36% of patients in the open group and 37% of patients in the laparoscopic group developed
hypothermia. This percentage increased to 46% in the open group and 41% in the laparoscopic group during the operation, and
then decreased to 6% in the open group and 8% in the laparoscopic group in the recovery-room. Core temperature increased during
the operative procedure to reach 36.5 ± 0.6°Cin the open group and 36.3 ± 0.5°Cin the laparoscopic group at 2.5 hours after surgical incision. Intra-abdominal temperature during laparoscopic GBP was significantly
lower than core temperature at all measurement points (p<0.05). Operative time was longer in the laparoscopic group than in
the open group (232 ± 43 vs 201 ± 38 min, p<0.01). Mean volume of gas delivered during laparoscopic GBP was 650 ± 220 liters.
Conclusion: Perioperative hypothermia was a common event during both laparoscopic and open GBP. Despite a longer operative
time, laparoscopic GBP did not increase the rate of intraoperative hypothermia when efforts were made to minimize intraoperative
Obesity Surgery 09/2001; 11(5):570-575. · 3.29 Impact Factor
ABSTRACT: Sildenafil is widely used as a primary pharmacological treatment of erectile dysfunction in men with and without underlying cardiovascular disease. Although initial reports of adverse cardiac events were reported soon after Food and Drug Administration approval of this agent, a large body of data suggests that sildenafil does not significantly increase the risk of nonfatal myocardial infarction, stroke, or cardiovascular deaths in patients with preexisting ischemic heart disease. We report the case of a 66-year-old man who developed thrombotic occlusion of the left anterior descending artery and presented with acute myocardial infarction after the use of sildenafil. The patient had presented with chest pain syndrome and borderline elevation of serum troponin I levels 1 week before sildenafil use, and a coronary angiogram had demonstrated normal coronary arteries. This case emphasizes the potential of precipitating coronary thrombosis in patients with unstable plaque after sildenafil use, even in patients with angiographically normal coronary arteries.
American Journal of Therapeutics 13(4):378-84. · 1.49 Impact Factor