Manish Parikh

Lincoln Hospital, Bellevue, Washington, United States

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Publications (43)142.38 Total impact

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    ABSTRACT: Objective: To compare bariatric surgery versus intensive medical weight management (MWM) in patients with type 2 diabetes mellitus (T2DM) who do not meet current National Institutes of Health criteria for bariatric surgery and to assess whether the soluble form of receptor for advanced glycation end products (sRAGE) is a biomarker to identify patients most likely to benefit from surgery. Background: There are few studies comparing surgery to MWM for patients with T2DM and BMI less than 35. Methods: Fifty-seven patients with T2DM and BMI 30 to 35, who otherwise met the criteria for bariatric surgery were randomized to MWM versus surgery (bypass, sleeve or band, based on patient preference). The primary outcomes assessed at 6 months were change in homeostatic model of insulin resistance (HOMA-IR) and diabetes remission. Secondary outcomes included changes in HbA1c, weight, and sRAGE. Results: The surgery group had improved HOMA-IR (-4.6 vs +1.6; P = 0.0004) and higher diabetes remission (65% vs 0%, P < 0.0001) than the MWM group at 6 months. Compared to MWM, the surgery group had lower HbA1c (6.2 vs 7.8, P = 0.002), lower fasting glucose (99.5 vs 157; P = 0.0068), and fewer T2DM medication requirements (20% vs 88%; P < 0.0001) at 6 months. The surgery group lost more weight (7. vs 1.0 BMI decrease, P < 0.0001). Higher baseline sRAGE was associated with better weight loss outcomes (r = -0.641; P = 0.046). There were no mortalities. Conclusions: Surgery was very effective short-term in patients with T2DM and BMI 30 to 35. Baseline sRAGE may predict patients most likely to benefit from surgery. These findings need to be confirmed with larger studies.
    Annals of Surgery 10/2014; 260(4):617-624. DOI:10.1097/SLA.0000000000000919 · 7.19 Impact Factor
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    ABSTRACT: Purpose The aim of this study was to determine the diagnostic accuracy of positron emission tomography (PET) in cancer patients undergoing adrenalectomy for presumed metastatic disease, utilizing the gold standard of histopathology. Methods We retrospectively reviewed all adrenalectomies for metastatic disease performed at our institution over the last 12 years. Preoperative PET scans were compared with final pathology reports. Statistical analyses were performed with Fisher’s exact test for categorical variables and Student’s t test for continuous variables. Results Forty-nine adrenalectomies were performed for metastatic disease. Thirty had preoperative PET imaging and were included in this analysis. Mean age was 65.5 ± 13.6 years (29–91) and 54 % were male. Mean size was 3.8 cm (0.4–7.1). Primary tumor distribution was 61 % (n = 17) pulmonary; 11 % (n = 3) breast; 7 % (n = 2) gastric; 7 % (n = 2) renal; and 4 % (n = 1) each of brain, lymphoma, melanoma, and uterine. Mean standardized uptake value (SUV) was 11 ± 7.3 (3.2–30.0). Final pathology revealed that 80 % (25/30) were positive for metastatic disease and 20 % (5/30) were negative. The positive predictive value of PET in correctly identifying adrenal metastatic disease was 83 % (24 true-positive cases and 5 false-positive cases); there was one false-negative PET. False-positive PET results were not correlated with sex (p = 0.35), age (p = 0.24), or maximum SUV units (p = 0.26). Conclusions The 20 % false-positive rate for PET-positive adrenalectomies performed for metastatic disease should warrant its inclusion in preoperative counseling to the patient and interaction with the treating oncologist.
    Annals of Surgical Oncology 08/2014; 22(2). DOI:10.1245/s10434-014-4031-9 · 3.94 Impact Factor
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    ABSTRACT: Bariatric surgery is the most effective treatment for patients suffering from obesity-related comorbidities. There is little data regarding how patients choose one particular bariatric procedure over another. This study aimed to better define the relationship between preferences of patients considering bariatric surgery and the procedure patients undergo. A bilingual questionnaire was administered to all prospective patients seen between March 1 and August 31, 2012. The questionnaire assessed basic knowledge of bariatric surgery (based on the information seminar) as well as patient preferences of the various outcomes and complications for sleeve gastrectomy, gastric bypass, and gastric banding. One hundred seventy-two patients completed the questionnaire. Fifty-eight percent of patients chose "maximum weight loss" as the most important outcome, and 65 % chose "leak" as the most concerning complication. Subgroup analysis of patients with diabetes revealed that 58 % chose "curing diabetes" as the most important outcome. Nineteen percent of patients were either not sure which procedure they wanted or changed their decision after consultation with the surgeon. The decision to choose one bariatric procedure over another is complex and is based on factors beyond absolute patient preferences. Although maximum weight loss is a commonly reported preference for patients seeking bariatric surgery, patients with diabetes are more focused on diabetes remission. Most patients have already decided which procedure to undergo prior to surgeon consultation. Patients may benefit from shared decision making, which integrates patient values and preferences along with current medical evidence to assist in the complex bariatric surgery selection process.
    Obesity Surgery 05/2014; 24(11). DOI:10.1007/s11695-014-1270-6 · 3.74 Impact Factor
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    ABSTRACT: Abnormality in distal lung function may occur in obesity due to reduction in resting lung volume; however, airway inflammation, vascular congestion and/or concomitant intrinsic airway disease may also be present. The goal of this study is to 1) describe the phenotype of lung function in obese subjects utilizing spirometry, plethysmography and oscillometry; and 2) evaluate residual abnormality when the effect of mass loading is removed by voluntary elevation of end expiratory lung volume (EELV) to predicted FRC. 100 non-smoking obese subjects without cardio-pulmonary disease and with normal airflow on spirometry underwent impulse oscillometry (IOS) at baseline and at the elevated EELV. FRC and ERV were reduced (44±22, 62±14% predicted) with normal RV/TLC (29±9%). IOS demonstrated elevated resistance at 20 Hz (R20, 4.65±1.07 cmH2O/L/s); however, specific conductance was normal (0.14±0.04). Resistance at 5-20 Hz (R5-20, 1.86±1.11 cmH2O/L/s) and reactance at 5 Hz (X5, -2.70±1.44 cmH2O/L/s) were abnormal. During elevation of EELV, IOS abnormalities reversed to or towards normal. Residual abnormality in R5-20 was observed in some subjects despite elevation of EELV (1.16±0.8 cmH2O/L/s). R5-20 responded to bronchodilator at baseline but not during elevation of EELV. This study describes the phenotype of lung dysfunction in obesity as reduction in FRC with airway narrowing, distal respiratory dysfunction and bronchodilator responsiveness. When R5-20 normalized during voluntary inflation, mass loading was considered the predominant mechanism. In contrast, when residual abnormality in R5-20 was demonstrable despite return of EELV to predicted FRC, mechanisms for airway dysfunction in addition to mass loading could be invoked.
    PLoS ONE 02/2014; 9(2):e88015. DOI:10.1371/journal.pone.0088015 · 3.53 Impact Factor
  • Nicole M Hindman, Stella Kang, Manish S Parikh
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    ABSTRACT: The interpretation of images obtained in patients who have recently undergone abdominal or pelvic surgery is challenging, in part because procedures that were previously performed with open surgical techniques are increasingly being performed with minimally invasive (laparoscopic) techniques. Thus, it is important to be familiar with the normal approach used for laparoscopic surgeries. The authors describe the indications for various laparoscopic surgical procedures (eg, cholecystectomy, appendectomy, hernia repair) as well as normal postoperative findings. For example, port site hernias are more commonly encountered in patients with trocar sites greater than 10 mm and occur at classic entry sites (eg, the periumbilical region). Similarly, preperitoneal air can be encountered postoperatively, often secondary to trocar dislodgement during difficult entry or positioning. In addition, intraperitoneal placement of mesh during commonly performed ventral or incisional hernia repairs typically leads to postoperative seroma formation. Familiarity with normal findings after commonly performed laparoscopic surgical procedures in the abdomen and pelvis allows accurate diagnosis of common complications and avoidance of diagnostic pitfalls. © RSNA, 2014.
    Radiographics 01/2014; 34(1):119-38. DOI:10.1148/rg.341125181 · 2.73 Impact Factor
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    ABSTRACT: The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved, unemployed patients with severe obesity. A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed. Preoperative patient questionnaires and medical records were reviewed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team. Follow-up data was obtained on all available patients (including those who did not undergo surgery), including weight and employment status. A standardized telephone questionnaire was administered to supplement details regarding employment. Changes in employment status and body weight were determined in both groups. Here, 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team. The vast majority of patients (>80 %) were minorities (primarily Hispanic) and publicly insured. Seventy-two underwent bariatric surgery and 121 did not. Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively (p = 0.043). There was a 10-point body mass index reduction in the surgical group, compared to 1-point reduction in the non-surgical group after one year. Bariatric surgery may improve employment status in an unemployed severely obese patient cohort. Future research in this area should collect detailed prospective data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment.
    Obesity Surgery 12/2013; 24(5). DOI:10.1007/s11695-013-1140-7 · 3.74 Impact Factor
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    Journal of the American College of Surgeons 07/2013; DOI:10.1016/j.jamcollsurg.2013.04.023 · 4.45 Impact Factor
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    Janice Lin, Manish Parikh, Jonathan Samuels
    01/2013; 2013:517803. DOI:10.1155/2013/517803
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    ABSTRACT: Purpose: To determine whether a discordance exists between the bariatric procedures patients choose (gastric bypass, gastric band, or sleeve gastrectomy) and their treatment-related values (outcomes and complications). Methods: An anonymous bilingual (English/Spanish) questionnaire was administered to new patients at the Bellevue Hospital Bariatric Surgery Program. The Bariatric Clinic requires patients to attend an information seminar and consult with a multidisciplinary team before making a surgical choice. The questionnaire was administered after the seminar, but before the consultation, and included knowledge questions on the outcome and complication profiles of the 3 surgical treatments and questions about the patients' treatment-related values. Results: 64 patients completed the questionnaire. The mean Body Mass Index (BMI) was 44.5 kg/m2 and 25.0% were diabetic. Patients answered correctly an average 62.9% of the knowledge questions. 42.2% of patients chose gastric bypass, 40.6% sleeve gastrectomy, and 17.2% gastric banding (Table 1). 29% of patients changed their surgical choice following consultation with the multidisciplinary team. In patients who chose gastric banding, 36.4% selected weight loss as their most important outcome (gastric banding affords the least weight loss of the 3 procedures). In diabetic patients, 36.4% cared more about weight loss than curing their diabetes. When patients' target BMI was calculated using preoperative BMI and evidence-based estimates of excess body weight loss for each of the 3 bariatric procedures, 66.7% of those who chose gastric banding had a target BMI above 35, meaning they would remain severely obese postoperatively. Conclusions: This study found that many patients choose a bariatric procedure with an outcome and complication profile that is inconsistent with their values, and that a significant subgroup of patients (29.0%) change their surgical choice after consultation with the medical team. These results strongly indicate that patients and physicians would benefit from a decision-making model, which integrates patient values, to assist in the complicated surgery selection process. Table 1. Outcome and complication profile for all patients Most important outcome Most worrisome complication Surgery #Patients (%) #Diabetic patients (%) Weight loss Curing diabetes Least weight regain Fewest appts. Leak Slip/ erosion Gastric bypass 27 (42.2) 9 (56.2) 59.3% 14.8% 25.9% 0 66.7% 33.3% Sleeve gastrectomy 26 (40.6) 6 (37.5) 61.5% 15.4% 23.1% 0 53.8% 46.2% Gastric band 11 (17.2) 1 (6.3) 36.4% 9.1% 54.6% 0 45.5% 54.5%
    The 34th Annual Meeting of the Society for Medical Decision Making; 10/2012
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    ABSTRACT: OBJECTIVE:: To conduct a systematic review to identify surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy (LSG). BACKGROUND:: LSG is growing in popularity as a primary bariatric procedure. Technical aspects of LSG including bougie size remain controversial. METHODS:: Our systematic review yielded 112 studies encompassing 9991 LSG patients. A general estimating equation (GEE) model was used to calculate the odds ratio (OR) for leak based on bougie size, distance from the pylorus, and use of buttressing on the staple line. Baseline characteristics, including age and body mass index (BMI), were included. A linear repeated measures regression model compared excess weight loss (%EWL) between bougie sizes. RESULTS:: A total of 198 leaks in 8922 patients (2.2%) were identified. The GEE model revealed that the risk of leak decreased with bougie ≥40 Fr (OR = 0.53, 95% CI = [0.37-0.77]; P = 0.0009). Buttressing did not impact leak. There was no difference in %EWL between bougie <40 Fr and bougie ≥40 Fr up to 36 months (mean: 70.1% EWL; P = 0.273). Distance from the pylorus did not affect leak or %EWL. CONCLUSIONS:: Utilizing bougie ≥40 Fr may decrease leak without impacting %EWL up to 3 years. Distance from the pylorus does not impact leak or weight loss. Buttressing does not seem to impact leak; however, if surgeons desire to buttress, bioabsorbable material is the most common type used. Longer-term studies are needed to definitively determine the effect of bougie size on weight loss after LSG.
    Annals of surgery 09/2012; 257(2). DOI:10.1097/SLA.0b013e31826cc714 · 7.19 Impact Factor
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    ABSTRACT: Surgical correction of hiatal hernia (HH) during bariatric surgery has been found to improve patient outcomes and decrease reoperation rate. Although barium esophagram is more sensitive than endoscopy for detection of HH, accurate preoperative diagnosis remains a challenge. The aim of this study is to determine whether diagnostic accuracy improves by utilizing right anterior oblique (RAO) esophagram technique instead of the commonly used upright technique when comparing to the gold standard of intraoperative detection. All patients undergoing bariatric surgery were prospectively evaluated for HH by barium esophagram. After the first 69 patients, the technique was changed from upright to RAO. Hiatal hernia was assessed intraoperatively by laxity of the phrenoesophageal ligament and, if present, was repaired posteriorly. Two board-certified radiologists specializing in gastrointestinal radiology, who were blinded to the intraoperative results, retrospectively reviewed the esophagrams. Consensus reads were utilized for divergent opinions. Sensitivity and specificity were calculated for each technique. Between 2008 and 2010, a total of 388 patients underwent preoperative esophagrams (69 upright, 388 RAO). For upright esophagram, sensitivity was 50 % and specificity was 97 %. For RAO esophagram, sensitivity was 70 % and specificity was 77 %. RAO had a lower percentage of false negatives (11 vs. 21 %) than upright esophagram. The use of RAO technique for preoperative esophagram is more sensitive for diagnosis of hiatal hernia than upright esophagram. If surgeons desire routine preoperative esophagram, RAO technique is the best.
    Obesity Surgery 07/2012; 22(11):1730-3. DOI:10.1007/s11695-012-0721-1 · 3.74 Impact Factor
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    ABSTRACT: BACKGROUND: Previous studies have shown accelerated gastric emptying after sleeve gastrectomy. This study aimed to determine whether a correlation exists between immediate postoperative gastroduodenal transit time and weight loss after laparoscopic sleeve gastrectomy (LSG). Specifically, correlation tests were conducted to determine whether more rapid transit after LSG correlated with increased weight loss. METHODS: Data were collected from an institutional review board-approved electronic registry. All LSGs were performed over a 40-Fr bougie, starting 5 to 7 cm proximal to the pylorus. Gastroduodenal transit time (antrum to duodenum) was calculated from a postoperative day 1 esophagram. Pearson's correlation coefficient was used for statistical analysis. RESULTS: The analysis included 62 consecutive LSG patients. The mean gastroduodenal transit time was 12.3 ± 19.8 s. Almost all the patients (99 %) had a transit time less than 60 s. The mean percentage of excess weight loss (%EWL) was 23.8 ± 9.8 % at 3 months, 37.9 ± 11.8 % at 6 months, and 52.2 ± 10.8 % at 12 months. No correlation was found between gastroduodenal transit time and %EWL at 3, 6, or 12 months. CONCLUSION: No correlation was found between gastroduodenal transit time and weight loss after LSG.
    Surgical Endoscopy 05/2012; 26(12). DOI:10.1007/s00464-012-2352-y · 3.31 Impact Factor
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    ABSTRACT: BACKGROUND: Genetic factors likely play a role in obesity and the outcomes after bariatric surgery. Single nucleotide polymorphisms in or near the insulin-induced gene 2 (INSIG-2), fat mass and obesity-associated gene (FTO), melanocortin 4 receptor gene (MC4R), and proprotein convertase subtilisn/kexin type 1 gene (PCSK-1) have been associated with class III obesity in whites. Minimal data are available regarding the genetic susceptibility to obesity in class III obese nonwhites, especially Hispanics. Our objective was to perform a comparative analysis of 4 common genetic variants (INSIG-2, FTO, MC4R, and PCSK-1) associated with obesity in a diverse population of bariatric surgery patients to determine whether a difference exists by ethnicity (white versus Hispanic). The setting of the study was 2 university hospitals in the United States. METHODS: Bariatric surgery patients from 2 different institutions were enrolled prospectively, and genotyping was performed. Differences in the distribution of INSIG-2, FTO, MC4R, and PCSK-1 single nucleotide polymorphisms among the different ethnicities (whites and Hispanics) were compared using an additive model (0, 1, or 2 risk alleles). A propensity-matched analysis was used to account for cohort differences. RESULTS: A total of 1276 bariatric patients were genotyped for the INSIG-2, FTO, MC4R, and PCSK-1 obesity single nucleotide polymorphisms. Statistically significant differences in FTO, INSIG-2, MC4R, and PCSK-1 were seen using an additive model. FTO, PCSK-1, and MC4R (test for trend) remained significantly different in the propensity analysis. CONCLUSION: Significant differences in the frequencies of several common obesity susceptibility variants in or near FTO, PCSK-1, and MC4R were found in white and Hispanic patients with class III obesity undergoing bariatric surgery. Larger studies in more class III obese Hispanics of different nationalities are needed.
    Surgery for Obesity and Related Diseases 05/2012; 9(3). DOI:10.1016/j.soard.2012.04.004 · 4.94 Impact Factor
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    ABSTRACT: Many insurance payors mandate that bariatric surgery candidates undergo a medically supervised weight management (MSWM) program as a prerequisite for surgery. However, there is little evidence to support this requirement. We evaluated in a randomized controlled trial the hypothesis that participation in a MSWM program does not predict outcomes after laparoscopic adjustable gastric banding (LAGB) in a publicly insured population. This pilot randomized trial was conducted in a large academic urban public hospital. Patients who met NIH consensus criteria for bariatric surgery and whose insurance did not require a mandatory 6-month MSWM program were randomized to a MSWM program with monthly visits over 6 months (individual or group) or usual care for 6 months and then followed for bariatric surgery outcomes postoperatively. Demographics, weight, and patient behavior scores, including patient adherence, eating behavior, patient activation, and physical activity, were collected at baseline and at 6 months (immediately preoperatively and postoperatively). A total of 55 patients were enrolled in the study with complete follow-up on 23 patients. Participants randomized to a MSWM program attended an average of 2 sessions preoperatively. The majority of participants were female and non-Caucasian, mean age was 46 years, average income was less than $20,000/year, and most had Medicaid as their primary insurer, consistent with the demographics of the hospital's bariatric surgery program. Data analysis included both intention-to-treat and completers' analyses. No significant differences in weight loss and most patient behaviors were found between the two groups postoperatively, suggesting that participation in a MSWM program did not improve weight loss outcomes for LAGB. Participation in a MSWM program did appear to have a positive effect on physical activity postoperatively. MSWM does not appear to confer additional benefit as compared to the standard preoperative bariatric surgery protocol in terms of weight loss and most behavioral outcomes after LAGB in our patient population.
    Surgical Endoscopy 03/2012; 26(3):853-61. DOI:10.1007/s00464-011-1966-9 · 3.31 Impact Factor
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    ABSTRACT: PURPOSE/AIM Laparoscopic surgeries are increasingly performed and produce unique postoperative imaging findings which may be misdiagnosed as complications. The purpose of this exhibit is to provide an interactive case-based guide to identifying normal post-surgical changes, complications, and diagnostic pitfalls specific to laparosopic surgery. CONTENT ORGANIZATION 1. Update on laparoscopic techniques including types of entry and trocars, along with expected postoperative changes on CT after laparoscopic surgery compared with open approach. 2. Pictorial review of potential pitfalls in interpretation leading to overdiagnosis of surgical complications, which may be avoided with knowledge of surgical approach and correlative clinical history. 3. Case-based quiz on post-operative findings, complications, and diagnostic pitfalls unique to laparoscopic surgery. SUMMARY Laparoscopic techniques are increasingly replacing open approaches to intra-abdominal procedures. Knowledge of the expected postoperative changes and complications unique to laparoscopic surgery may aid in accurate interpretation of CT scans in such patients and avoidance of unnecessary intervention.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    Acta gastroenterologica Latinoamericana 09/2011; 41(3):185, 266.
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    ABSTRACT: Obesity is frequently associated with respiratory symptoms despite normal large airway function as assessed by spirometry. However, reduced functional residual capacity and expiratory reserve volume are common and might reflect distal airway dysfunction. Impulse oscillometry (IOS) might identify distal airway abnormalities not detected using routine spirometry screening. Our objective was to test the hypothesis that excess body weight will result in distal airway dysfunction detected by IOS that reverses after bariatric surgery. The setting was a university hospital. A total of 342 subjects underwent spirometry, plethysmography, and IOS before bariatric surgery. Of these patients, 75 repeated the testing after the loss of 20% of the total body weight. The data from 47 subjects with normal baseline spirometry and complete pre- and postoperative data were analyzed. IOS detected preoperative distal airway dysfunction despite normal spirometry findings by an abnormal airway resistance at an oscillation frequency of 20 Hz (4.75 ± 1.2 cm H(2)O/L/s), frequency dependence of resistance from 5 to 20 Hz (2.20 ± 1.6 cm H(2)O/L/s), and reactance at 5 Hz (-3.47 ± 2.1 cm H(2)O/L/s). Postoperatively, the subjects demonstrated 57% ± 15% excess weight loss. The body mass index decreased (from 44 ± 6 to 32 ± 5 kg/m(2), P < .001). Improvements in functional residual capacity (from 59% ± 11% to 75% ± 20% predicted, P < .001) and expiratory reserve volume (from 41% ± 20% to 75% ± 20% predicted, P < .001) were demonstrated. Distal airway function also improved: airway resistance at an oscillation frequency of 20 Hz (3.91 ± .9, P < .001), frequency dependence of resistance from 5 to 20 Hz (1.17 ± .9, P < .001), and reactance at 5 Hz (-1.85 ± .9, P < .001). The present study detected significant distal airway dysfunction despite normal preoperative spirometry findings. The effect of increased body weight was likely the main mechanism for these abnormalities. However, the inflammatory state of obesity or associated respiratory disease could also be invoked. These abnormalities improved significantly toward normal after weight loss. The results of the present study highlight the importance of bariatric surgery as an effective intervention in reversing these respiratory abnormalities.
    Surgery for Obesity and Related Diseases 08/2011; 8(5):582-9. DOI:10.1016/j.soard.2011.08.004 · 4.94 Impact Factor
  • Manish Parikh, Laura Heacock, Michel Gagner
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    ABSTRACT: Weight regain after Roux-en-Y gastric bypass (RYGB) is increasingly reported in the bariatric literature. Laparoscopic sleeve reduction of the gastrojejunal complex is a surgical option to revise a dilated gastric pouch. We report our short-term results. Sleeve reduction entails serial firing of a linear stapler along the jejunal alimentary limb, across the gastric pouch and towards the left crus, with a bougie in place, thus, creating a new 20-25-cm reduced gastrojejunal complex. Data analyzed included age, body mass index (BMI), excess weight loss (EWL), comorbidity resolution, and any other simultaneous operative procedures. Fourteen patients were identified, all done laparoscopically. Nine underwent gastrojejunal sleeve reduction alone and five underwent additional lengthening of the Roux limb. There were no mortalities. Mean age at revision was 43 years (31-59). Mean BMI and EWL prior to revision were 35.5 ± 4.0 kg/m² and 48.9 ± 15.8%, respectively. Nine of 14 patients (64%) had obesity-related comorbidities prior to the revision. Average BMI decrease was 2.7 kg/m². Post-revision mean BMI and %EWL were 32.9 ± 4.7 kg/m² and 12.0 ± 13.9%, respectively, with mean follow-up of 12 months. Three of nine patients (33%) experienced improvement and/or resolution of comorbidities. We did not find a significant difference between pre-and post-revision mean BMI and %EWL (p = 0.13) even after separately evaluating those patients who underwent Roux limb lengthening (p = 0.16). For RYGB patients who regained weight, laparoscopic gastrojejunal sleeve reduction does not seem to offer a major therapeutic benefit. Additional malabsorptive Roux lengthening also does not provide a significant benefit. Other options should be considered, such as placing a band on the gastric pouch or conversion to duodenal switch.
    Obesity Surgery 05/2011; 21(5):650-4. DOI:10.1007/s11695-010-0274-0 · 3.74 Impact Factor

Publication Stats

753 Citations
142.38 Total Impact Points

Institutions

  • 2014
    • Lincoln Hospital
      Bellevue, Washington, United States
  • 2008–2014
    • NYU Langone Medical Center
      • Department of Surgery
      New York, New York, United States
    • Cornell University
      • Department of Surgery
      Итак, New York, United States
  • 2005–2014
    • CUNY Graduate Center
      New York, New York, United States
  • 2009–2012
    • Gracie Square Hospital, New York, NY
      New York, New York, United States
  • 2007–2011
    • New York Presbyterian Hospital
      New York City, New York, United States
    • Weill Cornell Medical College
      • Department of Surgery
      New York, New York, United States
  • 2010
    • Mount Sinai Medical Center
      New York, New York, United States