Bipan Chand

Loyola University Chicago, Chicago, Illinois, United States

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Publications (111)464.96 Total impact

  • Pornthep Prathanvanich, Bipan Chand
    Surgery for Obesity and Related Diseases 02/2015; DOI:10.1016/j.soard.2015.02.005 · 4.94 Impact Factor
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    ABSTRACT: Surgical management of medically refractory gastroparesis remains a challenge. Case series and small retrospective studies describe clinical benefits from surgical intervention; however, no study reports the efficacy of gastric electrical stimulation (GES) or Roux-en-Y gastrojejunostomy with or without near-total gastrectomy (RYGJ) in morbidly obese patients with severe gastroparesis. A chart review was performed on all morbidly obese patients (BMI > 35 kg/m(2)) who underwent GES or RYGJ for medically refractory gastroparesis from March 2002 to December 2012 at the Cleveland Clinic. The main outcomes examined were symptom improvement, postoperative complications, and change in BMI. A total of 20 morbidly obese patients underwent GES placement. Seven morbidly obese patients had RYGJ with or without resection of the remnant stomach surgery. All operations were completed laparoscopically. In GES group, 18 patients had initial symptom improvement (90 %) and 11 (55 %) rated their symptom improved at the last follow-up. During the average 23 months' follow-up, 9 patients (45 %) experienced at least one readmission for gastrointestinal reasons. Early complications included two infections at a simultaneously placed J-tube site and one seroma. In the RYGJ group, all patients, including 4 patients who failed GES and subsequently converted to RYGJ, experienced short-term symptom improvement and 5 patients (71 %) rated their symptoms as improved at last follow-up. One duodenal stump leak happened in the RYGJ group. There were no 30-day mortalities in either group. The BMI change after GES implantation was 0.6 ± 4 kg/m(2) versus -7.7 ± 4 kg/m(2) after RYGJ (p < 0.01). GES implantation and RYGJ are both effective in terms of symptom control for medically refractory gastroparesis in morbidly obese. Both options can be performed in a minimally invasive fashion with low morbidity. Patients who have no improvement of symptoms for refractory gastroparesis after GES implantation can be successfully converted laparoscopically to RYGJ.
    Surgical Endoscopy 01/2015; DOI:10.1007/s00464-014-3990-z · 3.31 Impact Factor
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    ABSTRACT: Placement of an adjustable gastric band (AGB) over the gastric pouch after RYGB failure has had varied results.Objective The aim of this study was to evaluate safety and outcomes of AGB after RYGB failure.SettingAcademic center, United StatesMethods We identified 28 patients who underwent laparoscopic placement of an AGB around the gastric pouch as a revisional procedure for inadequate weight loss or recidivism after RYGB between 2008-2011.ResultsTwenty-four (86%) patients had a dilated gastric pouch and/or stoma. The mean operative and adhesiolysis time was 137.9±52.3 and 83±51 minutes, respectively. History of a previous open RYGB was associated with a longer adhesiolysis time (p=0.03). Three (11%) major intraoperative and five (18%) early postoperative complications occurred. Late complications (all requiring band removal) were observed in 6 (21%) patients and included: ineffectiveness (n=2), dysphagia/esophageal dilation (n=2), band erosion (n=1), and peritonitis (n=1). In all four patients with a normal sized pouch and stoma at the time of band placement, the band was removed. After a mean follow-up of 38.3±14.8 months, the mean body mass index (BMI) change and median excess weight loss (EWL) after salvage banding were -3.6±4.5 kg/m2 and 12.7%, respectively. In the subset of patients with a dilated pouch/stoma, BMI less than 42 kg/m2 at the time of band placement was associated with a significantly higher EWL (41.4±37.0%) compared with a baseline BMI>42 kg/m2 (12.1±7.2%, p=0.03).Conclusions Salvage banding is technically challenging due to dense adhesions, carries significant morbidity, and is associated with only 13% additional EWL. However, this approach may still be an option in carefully selected patients, such as those with previous laparoscopic RYGB who have a dilated pouch and/or stoma and lower BMI.
    Surgery for Obesity and Related Diseases 11/2014; 11(3). DOI:10.1016/j.soard.2014.11.014 · 4.94 Impact Factor
  • Pornthep Prathanvanich, Bipan Chand
    Surgery for Obesity and Related Diseases 07/2014; 10(4). DOI:10.1016/j.soard.2014.04.017 · 4.94 Impact Factor
  • Pornthep Prathanvanich, Bipan Chand
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    ABSTRACT: Background Pulmonary depression remains a major concern when performing upper endoscopy in the morbidly obese patient. Objectives The aim of this prospective study is to determine the effects of sedation and role of capnography during preoperative upper endoscopy in obese patients. Setting Major tertiary medical referral center Methods 82 consecutive diagnostic upper gastrointestinal endoscopies were performed in morbidly obese patients in an outpatient setting. Data on amount of drug administration and cardiorespiratory change were recorded. Results Mean body mass index and duration of procedure was 46.4 ± 8.2 kg/m2and 9.4±2.5 minutes, respectively. The mean dose of propofol was 139.5±45.1 mg. No clinically significant cardiorespiratory complications occurred. Respiratory depression (RD) was seen in 33/82 (40.2%) patients and included a mean absolute change in EtCO2 of 7.1±8.5 mmHg from baseline (p = 0.001). 54/82(65.9%) patients had subclinical RD with 27/54 (50%) having RD. Abnormal EtCO2 detected all episodes of RD. The sensitivity and negative predictive value in determining RD by a change in EtCO2 >10 mmHg or an absent EtCO2 waveform during any point of the procedure was 81% and 78% respectively. The relative risk was 2.3. Conclusion Capnography provided a real time assessment of changes in ventilation and can detect early phases of respiratory depression. Utilization of propofol as a means for sedation, with extended advanced monitoring technique, can allow for reduced adverse outcomes in morbidly obese patients undergoing upper endoscopy.
    Surgery for Obesity and Related Diseases 05/2014; 11(1). DOI:10.1016/j.soard.2014.05.018 · 4.94 Impact Factor
  • Pornthep Prathanvanich, Bipan Chand
    Surgery for Obesity and Related Diseases 04/2014; 10(6). DOI:10.1016/j.soard.2014.04.010 · 4.94 Impact Factor
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    ABSTRACT: Background The outcome of incisional and ventral hernia repair depends on surgical technique, patient, and material. Permacol™ surgical implant (crosslinked porcine collagen) has been used for over a decade; however, there are few data on outcomes. This study is the largest retrospective multinational study to date to evaluate outcomes with Permacol™ surgical implant in the repair of incisional and ventral hernias. Methods Data were collected retrospectively on 343 patients treated for 213 incisional and 130 ventral hernias. Data evaluated included patient demographics, wound classification, surgical technique, morbidity, and recurrence rates. Results Median follow-up time was 649 days (max: 2857), median age 57 years (range 23–91), and BMI 32 kg/m2 (range 17.6–77.8). Two or more comorbidities were present in 70% of patients. Open surgery was performed in 220 (64%) patients. Permacol™ surgical implant was used as an underlay (250), sublay (39), onlay (37), or inlay (17). Surgical techniques included component separation (89; 25.9%), modified Stoppa technique (197; 57.4%), and Rives–Stoppa (17; 5.0%). CDC Surgical Wound Classification was Class I (190), Class II (103), Class III (28), and Class IV (22). Complications were seen in 40.5% (139) of the patients, with seroma (19%) and wound infection (15%) as the most common. Mesh removal occurred in 1 (0.3%) patient. Kaplan–Meier analysis demonstrated that the probabilities for hernia recurrence at one, two, and three years were 5.8%, 16.6%, and 31.0%, respectively. Conclusions Permacol™ surgical implant was shown to be safe with relatively low rates of hernia recurrence. Clinical Trial Registration Number NCT01214252 (http://www.clinicaltrials.gov)
    International Journal of Surgery (London, England) 04/2014; 12(4). DOI:10.1016/j.ijsu.2014.01.025 · 1.65 Impact Factor
  • Pornthep Prathanvanich, Bipan Chand
    Surgery for Obesity and Related Diseases 01/2014; 10(4). DOI:10.1016/j.soard.2014.01.002 · 4.94 Impact Factor
  • Pornthep Prathanvanich, Bipan Chand
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    ABSTRACT: A review of benefits, indications, techniques, and special populations when considering enteral access. The purpose of this article is not to provide an exhaustive in-depth review but to highlight major considerations when deciding which patient would benefit and what tools should be considered before procedure. The focus is limited to endoscopic enteral access and does not cover additional methods (radiologic or surgical).
    Techniques in Gastrointestinal Endoscopy 10/2013; 15(4):216–223. DOI:10.1016/j.tgie.2013.07.001
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    ABSTRACT: Evaluate the long-term effects of bariatric surgery on type 2 diabetes (T2DM) remission and metabolic risk factors. Although the impressive antidiabetic effects of bariatric surgery have been shown in short- and medium-term studies, the durability of these effects is uncertain. Specifically, long-term remission rates following bariatric surgery are largely unknown. Clinical outcomes of 217 patients with T2DM who underwent bariatric surgery between 2004 and 2007 and had at least 5-year follow-up were assessed. Complete remission was defined as glycated hemoglobin (A1C) less than 6% and fasting blood glucose (FBG) less than 100 mg/dL off diabetic medications. Changes in other metabolic comorbidities, including hypertension, dyslipidemia, and diabetic nephropathy, were assessed. At a median follow-up of 6 years (range: 5-9) after surgery (Roux-en-Y gastric bypass, n = 162; gastric banding, n = 32; sleeve gastrectomy, n = 23), a mean excess weight loss (EWL) of 55% was associated with mean reductions in A1C from 7.5% ± 1.5% to 6.5% ± 1.2% (P < 0.001) and FBG from 155.9 ± 59.5 mg/dL to 114.8 ± 40.2 mg/dL (P < 0.001). Long-term complete and partial remission rates were 24% and 26%, respectively, whereas 34% improved (>1% decrease in A1C without remission) from baseline and 16% remained unchanged. Shorter duration of T2DM (P < 0.001) and higher long-term EWL (P = 0.006) predicted long-term remission. Recurrence of T2DM after initial remission occurred in 19% and was associated with longer duration of T2DM (P = 0.03), less EWL (P = 0.02), and weight regain (P = 0.015). Long-term control rates of low high-density lipoprotein, high low-density lipoprotein, high triglyceridemia, and hypertension were 73%, 72%, 80%, and 62%, respectively. Diabetic nephropathy regressed (53%) or stabilized (47%). Bariatric surgery can induce a significant and sustainable remission and improvement of T2DM and other metabolic risk factors in severely obese patients. Surgical intervention within 5 years of diagnosis is associated with a high rate of long-term remission.
    Annals of surgery 10/2013; 258(4):628-37. DOI:10.1097/SLA.0b013e3182a5034b · 7.19 Impact Factor
  • Pornthep Prathanvanich, Bipan Chand
    Gastrointestinal endoscopy 09/2013; 78(6). DOI:10.1016/j.gie.2013.07.038 · 4.90 Impact Factor
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    Bipan Chand, Pornthep Prathanvanich
    Gastrointestinal Endoscopy 05/2013; 05(02). DOI:10.1016/j.gie.2013.03.740 · 4.90 Impact Factor
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    ABSTRACT: BACKGROUND & AIMS: Weight regain or insufficient loss following Roux-en-Y gastric bypass (RYGB) is common. This is partially attributable to dilatation of the gastrojejunostomy (GJ), which diminishes the restrictive capacity of RYGB. Endoluminal interventions for GJ reduction are being explored as alternatives to revision surgery. We performed a randomized, blinded, sham-controlled trial to evaluate weight loss following sutured transoral outlet reduction (TORe). METHODS: Patients with weight regain or inadequate loss after RYGB and GJ diameter > 2 cm were randomly assigned to groups that underwent TORe (n=50) or a sham procedure (controls, n=27). Intra-operative performance, safety, weight loss and clinical outcomes were assessed. RESULTS: Subjects that received TORe had a significantly greater mean percent weight loss, from baseline (3.5%; 95% confidence interval [CI], 1.8%-5.3%), than controls (0.4%; 95% CI, 2.3% weight gain to 3.0% weight loss) (P=.021), using last observation carried forward intent-to-treat analysis. As-treated analysis also demonstrated greater mean percent weight loss in the TORe group than controls (3.9% and 0.2% respectively; P=.014). Weight loss or stabilization was achieved in 96% subjects receiving TORe and 78% of controls (P=.019). The TORe group had reduced systolic and diastolic blood pressure (P<.001) and a trend toward improved metabolic indices. Additionally, 85% of the TORe group reported compliance with the healthy lifestyle eating program, compared with 53.8% of controls; 83% of TORe subjects said they would undergo the procedure again, and 78% said they would recommend the procedure to a friend. The groups had similar frequencies of adverse events. CONCLUSIONS: A multi-center randomized trial provides Level I evidence that TORe reduces weight regain following RYGB. These results were achieved using a superficial suction-based device; greater levels of weight loss could be achieved with newer, full-thickness suturing devices. TORe is one approach to avoid weight regain; a longitudinal multidisciplinary approach with dietary counseling and behavioral changes are required for long-term results.
    Gastroenterology 04/2013; DOI:10.1053/j.gastro.2013.04.002 · 13.93 Impact Factor
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    ABSTRACT: Complications of laparoscopic adjustable gastric banding (LAGB) include band slippage, material infection, and band erosion. Band erosion can lead to chronic infection, obstruction, delayed perforation, and ineffectiveness; therefore, removal is indicated. A myriad of approaches exist for band removal and many authors have described novel techniques. A minimally invasive approach, including laparoscopic or endoscopic assistance, is favored given the reduction of postoperative complications compared with laparotomy. We present a novel approach to band retrieval following partial erosion involving a complete endoscopic/transgastric technique. Perioperative management and a review of the literature also are described.
    Surgical Endoscopy 03/2013; 27(8). DOI:10.1007/s00464-013-2856-0 · 3.31 Impact Factor
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    ABSTRACT: BACKGROUND: Gastric electrical stimulator (GES) implantation is effective in certain patients with gastroparesis; however, laparotomy is often employed for placement. The aim of this study is to review outcomes of patients who underwent laparoscopic GES therapy for diabetic and idiopathic gastroparesis at a large referral center. METHODS: Patients who underwent GES (Enterra Therapy System; Medtronic, Minneapolis, MN) implantation with subsequent interrogation and programming between March 2001 and November 2011 were analyzed. RESULTS: A total of 113 patients underwent GES placement or revision during the study period. One hundred eleven patients underwent primary GES at our institution, while two patients underwent GES generator revision at our institution. Primary operations were completed laparoscopically in 110 of 111 cases, with one conversion to laparotomy due to severe adhesions. At a mean follow-up of 27 months (1-113), symptom improvement was achieved in 91 patients (80 %) and was similar for both the diabetic and idiopathic subgroups. Need for supplemental nutrition (enteral and/or parental) decreased in both groups. CONCLUSIONS: GES placement is feasible using a laparoscopic approach. Medical refractory gastroparesis in the diabetic and idiopathic groups had significant symptom improvement with no difference between the two groups. Need for supplemental nutrition is decreased following GES.
    Journal of Gastrointestinal Surgery 01/2013; 17(3). DOI:10.1007/s11605-012-2128-7 · 2.39 Impact Factor
  • Surgery for Obesity and Related Diseases 01/2013; 9(1):152-3. DOI:10.1016/j.soard.2012.09.005 · 4.94 Impact Factor
  • Bipan Chand
    Surgery for Obesity and Related Diseases 01/2013; 10(2):297-298. DOI:10.1016/j.soard.2013.11.008 · 4.94 Impact Factor
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    ABSTRACT: Recent enthusiasm in the surgical community for less invasive surgical approaches has resulted in widespread application of single-incision techniques. This has been most commonly applied in laparoscopic cholecystectomy in general surgery. Cosmesis appears to be improved, but other advantages remain to be seen. Feasibility has been demonstrated, but there is little description in the current literature regarding complications. Patient and Methods: We report the case of a patient who previously underwent single-incision laparoscopic cholecystectomy for symptomatic gallstone disease. After a brief symptom-free interval, she developed acute pancreatitis. At evaluation, imaging results of ultrasonography and magnetic resonance cholangiopancreatography demonstrated a retained gallbladder with cholelithiasis. The patient was subsequently referred to our hospital, where she underwent further evaluation and surgical intervention. Our patient underwent 4-port laparoscopic remnant cholecystectomy with transcystic common bile duct exploration. Operative exploration demonstrated a large remnant gallbladder and a partially obstructed cystic duct with many stones. Transcystic exploration with balloon extraction resulted in duct clearance. The procedure took 75 minutes, with minimal blood loss. The patient's postoperative course was uneventful. Final pathology results demonstrated a remnant gallbladder with cholelithiasis and cholecystitis. This report is the first in the literature to describe successful laparoscopic remnant cholecystectomy and transcystic common bile duct exploration after previous single-port cholecystectomy. Although inadvertent partial cholecystectomy is not unique to this technique, single-port laparoscopic procedures may result in different and significant complications.
    JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 01/2013; 17(1):143-7. DOI:10.4293/108680812X13517013317356 · 0.79 Impact Factor
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    ABSTRACT: BACKGROUND: Changes in the biliary system after gastric bypass are not well defined. Dilation may be normal or due to biliary tract pathology. The purpose of this study is to review patients who underwent imaging of their biliary system both before and after Roux-en-Y gastric bypass in an effort to elucidate the effect this operation has on hepatic duct diameter. METHODS: Patients with imaging both before and at least 3 months after gastric bypass were analyzed. Hepatic duct was measured at the level of the porta hepatis to determine interval changes. RESULTS: Thirty-three patients had postoperative imaging at least 3 months following gastric bypass. Mean hepatic duct diameter was 5.2 ± 2 and 7.1 ± 2.6 mm preoperatively and postoperatively, respectively (p < 0.01). Patients with prior cholecystectomy had hepatic duct diameters of 7.9 ± 1.3 and 9.5 ± 3.5 mm preoperatively and postoperatively, respectively (p = 0.3). Patients who had not previously undergone cholecystectomy had hepatic duct diameters of 4.3 ± 1.1 and 6.4 ± 1.8 mm preoperatively and postoperatively, respectively (p < 0.01). CONCLUSIONS: Hepatic duct diameter increases after Roux-en-Y gastric bypass. A better understanding of this phenomenon may limit the need for further work-up in patients with incidentally detected biliary dilation.
    Journal of Gastrointestinal Surgery 10/2012; 16(12). DOI:10.1007/s11605-012-2058-4 · 2.39 Impact Factor
  • Bipan Chand
    Gastrointestinal endoscopy 10/2012; 76(4):761-2. DOI:10.1016/j.gie.2012.07.019 · 4.90 Impact Factor

Publication Stats

956 Citations
464.96 Total Impact Points

Institutions

  • 2013–2014
    • Loyola University Chicago
      • Department of Surgery
      Chicago, Illinois, United States
  • 2012–2014
    • Loyola University
      New Orleans, Louisiana, United States
  • 2012–2013
    • Loyola University Medical Center
      • • Stritch School of Medicine
      • • Department of Surgery
      Maywood, Illinois, United States
  • 2007–2012
    • Cleveland Clinic
      • Department of General Surgery
      Cleveland, Ohio, United States
    • Permanente Medical Group
      Pasadena, California, United States
  • 2006–2011
    • Bariatric Institute of Greater Chicago
      Hinsdale, Illinois, United States
    • George Washington University
      Washington, Washington, D.C., United States
  • 2010
    • Kuwait University
      • Department of Surgery
      Kuwait, Muhafazat al `Asimah, Kuwait