Objective: To investigate the effect of visceral fat area (VFA) on the surgical efficacy and early postoperative complications of radical gastrectomy for gastric cancer. Methods: A retrospective cohort study method was used. Clinicopathological data and preoperative imaging data of 195 patients who underwent D2 radical gastric cancer surgery at the First Affiliated Hospital of Xi'an Jiaotong University from January 2014 to December 2017 were analyzed retrospectively. Inclusion criteria: (1) complete clinicopathological and imaging data; (2) malignant gastric tumor diagnosed by preoperative pathology, and gastric cancer confirmed by postoperative pathology; (3) no preoperative complications such as bleeding, obstruction or perforation, and no distant metastasis. Those who had a history of abdominal surgery, concurrent malignant tumors, poor basic conditions, emergency surgery, palliative resection, and preoperative neoadjuvant therapy were excluded. The VFA was calculated by software and VFA ≥ 100 cm² was defined as visceral obesity according to the Japan Obesity Association criteria . The patients were divided into high VFA (VFA-H, VFA≥100 cm², n=96) group and low VFA (VFA-L, VFA<100 cm², n=99) group . The clinicopathological characteristics, surgical outcomes and early postoperative complications were compared between the two groups. Univariate and multivariate Logistic regression models were used to analyze the risk factors of early complications. Receiver operating characteristic (ROC) curve was used to analyze predictive values of VFA for early complications. Pearson's χ² test was used to analyze the correlation between BMI and VFA. Results: There were no significant differences in terms of gender, age, American Society of Anesthesiologists physical status classification, preoperative comorbidities, preoperative anemia, tumor TNM staging, N staging, T staging and tumor differentiation, surgical method, extent of resection, and tumor location between the VFA-L group and the VFA-H group (all P>0.05). However, patients in the VFA-H group had higher BMI, larger tumor, lower rate of hypoalbuminemia and greater subcutaneous fat area (SFA) (all P<0.05). The VFA-H group presented significantly longer operation time and significantly less number of harvested lymph nodes as compared to the VFA-L group (both P<0.05). However, there were no significant differences in intraoperative blood loss, conversion to laparotomy and postoperative hospital stay (all P>0.05). Complications of Clavien-Dindo grade II and above within 30 days after operation were mainly anastomosis-related complications (leakage, bleeding, infection and stricture), intestinal obstruction and incision infection. The VFA-H group had a higher morbidity of early complications compared to the VFA-L group [24.0% (23/96) vs 10.1% (10/99), χ²=6.657, P=0.010], and the rates of anastomotic complications and incision infection were also higher in the VFA group [10.4% (10/96) vs. 3.0% (3/99), χ²=4.274, P=0.039; 7.3% (7/96) vs. 1.0% (1/99), P=0.033]. Multivariate logistic analysis showed that high BMI (OR=3.688, 95%CI: 1.685-8.072, P=0.001) and high VFA (OR=2.526, 95%CI: 1.148-5.559,P=0.021) were independent risk factors for early complications. The area under the ROC curve (AUC) of VFA for predicting early complications was 0.645, which was higher than that of body weight (0.591), BMI (0.624) and SFA (0.626). Correlation analysis indicated that there was a significantly positive correlation between BMI and VFA (r=0.640, P<0.001). Conclusion: VFA ≥ 100 cm² is an independent risk factor for early complications after radical gastrectomy for gastric cancer.It can better predict the occurrence of above early postoperative complications.
Gastrectomy/methods* ; Humans ; Laparoscopy/methods* ; Lipids ; Obesity/surgery* ; Obesity, Abdominal/surgery* ; Postoperative Complications/epidemiology* ; Retrospective Studies ; Stomach Neoplasms/pathology*

Bariatric surgery has evolved from the surgical measure to treat morbid obesity into the epochal remedy to treat metabolic syndrome as a whole, which is represented by type 2 diabetes. Numerous clinical trials have unanimously advocated bariatric or metabolic surgery over the non-surgical interventions, demonstrating markedly superior metabolic outcomes not only in morbidly obese patients who satisfy traditional criteria for bariatric surgery (body mass index [BMI] >35kg/m²) but also in less obese or even in simply overweight patients. Nevertheless, not all the diabetic patients can achieve the most desirable outcomes, that is, diabetes remission, after metabolic surgery and candidates for metabolic surgery should be selected carefully based on the comprehensive preoperative assessment of the risk-benefit ratio. Predictors for diabetes remission after metabolic surgery can be largely classified into 2 groups based the mechanism of action; 1) indices for the preserved pancreatic beta-cell function, such as younger age, shorter duration of diabetes, and higher C-peptide level, and 2) those represent the potential reserve for reduction in insulin resistance, such as higher baseline BMI, and visceral fat area. Several prediction models for diabetes remission have been suggested by merging these predictors to guide clinicians and patients' joint decision-making process. Among them, 3 models, DiaRem, ABCD, and Individualized Metabolic Surgery (IMS) scores provide intuitive scoring systems which can be simply utilized in the routine clinical practice and have been validated in the independent external cohort. These prediction models need further validation in the various different ethnicities to ensure the universal applicability.
Bariatric Surgery ; C-Peptide ; Cohort Studies ; Humans ; Insulin Resistance ; Intra-Abdominal Fat ; Joints ; Obesity, Morbid ; Overweight

PURPOSE: Band erosion is a well-known complication of laparoscopic adjustable gastric band placement. We gained experience with laparoscopic removal of an eroded gastric band. METHODS: We retrospectively reviewed the operative log of our obesity surgery unit to identify all operations performed for band erosion from March 2009 to May 2011. RESULTS: During the study period, a total of six of 96 patients (6.3%), five females and one male, were diagnosed with band erosion and underwent surgical removal of the band system. The median time interval from the initial gastric band placement to the diagnosis of band erosion was 8.5 months (range, 7 to 22 months), with most band erosion occurring within the first year (5/6, 83%). The median body mass index at band removal was 28.4 kg/m2. Upper abdominal pain was the most common symptom (5/6, 83%), and other signs and symptoms were port site infection (3/6, 50%) and loss of restriction and weight regain (1/6, 17%). All eroded bands were removed using laparoscopy. Further complications after laparoscopic removal of the band system were observed in three cases. One patient showed multiple intra-abdominal abscesses requiring insertion of a pigtail catheter for drainage. The other two patients experienced sepsis with localized peritonitis, eventually requiring laparoscopic washout and drainage. CONCLUSION: Gastric band erosion requires the removal of the gastric band. Laparoscopic removal is technically achievable in the majority of patients with eroded gastric band. The method can be challenging, has potential postoperative complications (fistula, abscess), and should be attempted only by experienced surgeons.
Abdominal Abscess ; Abdominal Pain ; Bariatric Surgery ; Body Mass Index ; Catheters ; Cytochrome P-450 CYP1A1 ; Drainage ; Female ; Humans ; Laparoscopy ; Male ; Obesity ; Obesity, Morbid ; Peritonitis ; Postoperative Complications ; Retrospective Studies ; Sepsis

Bariatric surgery is considered to be the effective treatment alternative conducted over the lifetime for reducing weight in patients with clinically morbid obesity. For many patients, the benefits of weight loss, including decreases in blood glucose, lipids, and blood pressure as well as increase in mobility, will outweigh the risks of surgical complications. But patients undergoing bariatric surgery have the least risk for long-term diet-related complications as reported in several studies. Thus, with an increasing number of severely obese patients undergoing bariatric surgery, the multidisciplinary healthcare system will need to be managed continuously. Many nutrition support specialists will need to become familiar with the metabolic consequences for the frequent monitoring of nutrition status of the patients. South Korea has a very short history with bariatric surgery, and relatively few studies have been conducted on bariatric surgery. Therefore, the objective of this report was to compare the nutrient intake, weight loss, body fat composition, and visceral fat before and after the bariatric surgery.
Adipose Tissue* ; Bariatric Surgery* ; Blood Glucose ; Blood Pressure ; Delivery of Health Care ; Dietary Fats ; Humans ; Intra-Abdominal Fat* ; Korea ; Nutritional Status ; Obesity ; Obesity, Morbid ; Specialization ; Weight Loss

OBJECTIVETo evaluate the changes in body fat distribution after gastric bypass in gastric cancer patients with metabolic syndrome.

METHODSFrom July 2009 to February 2010, 26 patients with gastric cancer and concurrent metabolic syndrome were prospectively enrolled and underwent gastric bypass surgery at the Fuzhou General Hospital of Nanjing Military Command. Body mass index(BMI), waist circumference, hip circumference, insulin and insulin resistance index were measured before operation and at postoperative 1, 4, 12, 24, 48 weeks.

RESULTSAfter gastric bypass surgery, metabolic syndrome was improved including obesity, hypertension, disturbance of lipid and hyperglycemia. After 48 weeks postoperatively HOMA-IR decreased from 5.7 ± 1.5 to 3.4 ± 1.0 (P<0.05). BMI decreased from (27.1 ± 3.8) kg/m(2) to (22.6 ± 1.4) kg/m(2) (P<0.05). Indices for central obesity: waist circumference decreased from (95.3 ± 2.5) cm to (75.3 ± 1.1) cm, and visceral fat area decreased from(101.7 ± 13.8) cm(2) to (78.7 ± 11.2) cm(2) (P<0.05). There were no decline in peripheral obesity indices including hip circumference and subcutaneous fat area(P>0.05).

CONCLUSIONSThe distribution of body fat after gastric bypass changes from central obesity to peripheral obesity. Improvement of insulin resistance after gastric bypass surgery is associated with the decrease in central obesity indices.

Adult ; Body Fat Distribution ; Gastric Bypass ; Humans ; Metabolic Syndrome ; metabolism ; surgery ; Middle Aged ; Obesity ; pathology ; Obesity, Abdominal ; Postoperative Period ; Prospective Studies

Bariatric surgery is becoming increasingly more common for the treatment of morbid obesity. Preoperative weight loss leads to decreases in the size of the liver and the amount of intra-abdominal fat, which improve the surgical field and therefore the operative times and complication rates as well. Well-planned dietary advancement ensures proper healing from the surgery and develops life-long healthy eating habits. The recommended postoperative diet starts with soft food and gradually advances to solid food. Bariatric surgery has the potential to cause a variety of nutritional and metabolic complications, which are mostly due to the extensive surgically-induced anatomical changes incurred by the patient's gastrointestinal tract. Counseling, monitoring, and nutrient and mineral supplementation are essential for treatment, and dietary intake and eating behavior after bariatric surgery should also be changed to achieve long-lasting success. Structured nutritional counseling can help weight reduction and maintenance.
Bariatric Surgery ; Counseling ; Diet ; Eating ; Feeding Behavior ; Gastrointestinal Tract ; Intra-Abdominal Fat ; Liver ; Obesity, Morbid ; Operative Time ; Weight Loss

Obesity, that is, having a body mass index (BMI) >30 kg/m2, has increased dramatically and became the most single most common preventable cause of death in South Korea. In the end, obesity results in metabolic syndrome, which includes abdominal obesity, increased triglycerides, decreased high-density lipoprotein, hypertension, and impaired glucose tolerance. Nonsurgical methods for obesity treatments include dietary therapy, exercise counseling, behavioral therapy, psychiatric therapy, and pharmacotherapy. Surgical methods for obesity treatments, laparoscopic gastric banding and Roux-en-Y gastric bypass, are commonly performed for obese patients, particularly those with a BMI of 40 kg/m2 or at BMI more than 30 kg/m2 with accompanying diseases related to metabolic syndrome such as hypertension, type 2 diabetes, hypercholesterolemia, asthma, angina, other cardiopulmonary diseases, infertility, polycystic ovary, urinary incontinence, severe arthritis, or Pickwickian syndrome. Preoperative evaluation for bariatric surgery should focus on airway management, sleep apnea history, use of a continuous positive airway pressure device, and comorbid systemic diseases. Special consideration and pharmacokinetic knowledge is needed for the choice and dose of the anesthetic agents as well as postoperative pain control, patient monitoring, fluid intake, and surgical complications. Obesity is a disease. Appropriate surgical intervention and peri-operative anesthetic care for bariatric surgery will increase the safety and satisfaction of obese patients and will finally provide a better quality of life for our society.
Airway Management ; Anesthesia ; Anesthetics ; Arthritis ; Asthma ; Bariatric Surgery ; Body Mass Index ; Cause of Death ; Continuous Positive Airway Pressure ; Counseling ; Exercise Therapy ; Female ; Gastric Bypass ; Glucose ; Humans ; Hypercholesterolemia ; Hypertension ; Infertility ; Lipoproteins ; Monitoring, Physiologic ; Obesity ; Obesity Hypoventilation Syndrome ; Obesity, Abdominal ; Ovary ; Pain, Postoperative ; Quality of Life ; Republic of Korea ; Sleep Apnea Syndromes ; Triglycerides ; Urinary Incontinence

PURPOSE: The purpose of this study was to evaluate the overall rate and risk factors for the development of an incisional hernia and a parastomal hernia after colorectal surgery. METHODS: The study cohort consisted of 795 consecutive patients who underwent open colorectal surgery between 2005 and 2007 by a single surgeon. A retrospective analysis of prospectively collected data was performed. RESULTS: The overall incidence of incisional hernias was 2% (14/690). This study revealed that the cumulative incidences of incisional hernia were 1% at 12 months and 3% after 36 months. Eighty-six percent of all incisional hernias developed within 3 years after a colectomy. The overall rate of parastomal hernias in patients with a stoma was 6.7% (7/105). The incidence of parastomal hernias was significantly higher in the colostomy group than in the ileostomy group (11.9% vs. 0%; P = 0.007). Obesity, abdominal aortic aneurysm, American Society of Anesthesiologists score, serum albumin level, emergency surgery and postoperative ileus did not influence the incidence of incisional or parastomal hernias. However, the multivariate analysis revealed that female gender and wound infection were significant risk factors for the development of incisional hernias female: P = 0.009, wound infection: P = 0.041). There were no significant factors related to the development of parastomal hernias. CONCLUSION: Our results indicate that most incisional hernias develop within 3 years after a colectomy. Female gender and wound infection were risk factors for the development of an incisional hernia after colorectal surgery. In contrast, no significant factors were found to be associated with the development of a parastomal hernia.
Aortic Aneurysm ; Cohort Studies ; Colectomy ; Colorectal Surgery ; Colostomy ; Emergencies ; Female ; Hernia ; Hernia, Ventral ; Humans ; Ileostomy ; Ileus ; Incidence ; Multivariate Analysis ; Obesity, Abdominal ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Serum Albumin ; Surgical Stomas ; Wound Infection