Ulcerogenesis Following Gastric Procedure for Obesity.
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Biomedical subjects
IG Cleator
Publications and source records attributed to IG Cleator.
Laparoscopic Ileogastrostomy for Morbid Obesity.
This paper describes the technique of laparoscopic ileogastrostomy which we developed during the summer of 1993. The procedure is identical to that of our 'open' ileogastrostomy except that it is performed laparoscopically. The aim of the surgery is to increase ambulation of the patient, while reducing pain, morbidity, and the chance of apnea (due to impaired breathing in the first 24 h following conventional surgery), by carrying out surgery for the morbidly obese person through a laparoscope. This form of laparoscopic surgery may be completed within 4 h and, as our staff gains more experience with laparoscopic ileogastrostomy, we expect patient stays to be 2-3 days in length. Pulmonary function tests at 24 h show a great advantage in favor of the laparoscopic approach. Response of the medical team to this procedure was that it was more time-consuming and demanding than open surgery.
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Helicobacter pylori-induced Diarrhea Ileogastrostomy.
A retrospective study of all ileogastrostomy procedures (n = 26) performed in 1993 by one surgeon (IGMC) was carried out to investigate the hypothesis that Helicobacter pylori may be implicated in certain severe cases of postoperation nausea and diarrhea. Ten of 26 persons (38.5%) displayed nausea and notable diarrhea (greater than or equal to ten bowel movements per day), seven of which warranted upper GI investigation. One hundred per cent (seven of seven) of these persons were found to possess H. pylori upon C-14 breath test. In four of six cases eradication therapy (1 g amoxicillin b.i.d./20 mg omeprazole b.i.d. for 2 weeks) corresponded with a resolution of severe nausea and diarrhea (one additional case involved omeprazole use only), suggesting that H. pylori should be considered as a possible cause of these symptoms post-ileogastrostomy. Additionally, in four of seven cases persons were re-tested (C-14 breath analysis) at least 1 month post-therapy and in this group three persons were found to be free of the organism. All three cases of notable diarrhea and nausea resolved with treatment, providing the strongest evidence for a possible association between infection and these symptoms.
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Mechanisms of Weight Loss following Intestinal Bypass Surgery.
Dramatic weight loss has been observed following intestinal bypass surgery. Initially, malabsorption was recognized as the major cause of weight loss. Only in recent years have investigators noted that the intestinal bypass could significantly reduce caloric intake, which largely or almost fully explains the weight loss following this procedure. The reduced energy intake as well as malabsorption are probably the major causes of weight loss after intestinal bypass surgery. Increased energy output has been proposed as a factor for weight loss, and more recently, it has been suggested that certain hormonal changes may play a role in regulating satiety and metabolic processes. This article examines these proposed factors that may impact on weight loss following intestinal bypass surgery.
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Laparoscopic Ileogastrostomy.
Laparoscopic ileogastrostomy was successfully performed on two of three morbidly obese persons. In our first case, access ports proved too short and the patient was converted to an open procedure. Aims were to carry out surgery for the morbidly obese patient through a laparoscope and, as a consequence, increase ambulation, while reducing pain, morbidity, and the chance of apnea (due to impaired breathing in the first 24 h following conventional surgery). Length of laparoscopic surgeries for the second and third patients were 5 and 4 h, respectively, while hospital stays were 10 days and 5 days. Pulmonary function tests at 24 h were carried out and showed a great advantage in favor of the laparoscopic approach. Response of the medical team to this procedure was that it was more time-consuming and demanding than open surgery. Although gastric banding and gastric stapling have been accomplished laparoscopically, we believe these to be the first procedures with anastomoses carried out on morbidly obese patients.
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Quality of Life Assessment, of Ileogastrostomy.
Twenty of 26 (77%) consecutive Patients undergoing ileogastrostomy, performed by the same surgeon (IGMC) between February 1989 and May 1992, responded to a mailed quality of life survey. Average present weight was reported as 50.9 kg less than a mean preoperative weight of 139.7 kg. Mean time of follow-up was 24.75 months. When comparing perceptions before and after surgery, several quality of life improvements were noted in the areas of vocation, relationships, emotional well-being and physical well-being. Post-surgery, jobs were rated more satisfying, eating habits improved, self-image and self-confidence increased and body disparagement declined. Satisfaction with sexual relations increased, as did frequency. In general, relations with partners, coworkers and friends seemed to improve. Exercise also increased significantly. In contrast, foul flatus, bloating, and bowel movements regularly hampered activities or caused embarrassment when in public. Despite these physical side-effects, we observed that a large majority of persons undergoing ileogastrostomy noted significant improvements in quality of life.
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The Mechanism of Weight Loss after Ileo-gastrostomy for Morbid Obesity.
Twelve patients (weight 107-178 kg and age range 19-43 years) were investigated following ileo-gastrostomy for morbid obesity. A number of variables were studied prospectively, pre- and postoperatively, to determine the cause of weight loss-previously attributed to malabsorption or decreased caloric intake. Weight loss of 10.9-36.5 kg, mean 22.9 kg, occurred. Three-day calorie counts demonstrated a postoperative decrease in daily caloric consumption of 320-3870, mean 1975 cal. Analysis of body compartment composition after derivation of lean body mass (from calculation of total body water with tritiated water) showed a mean decrease in adipose tissue of 17.7 kg. Postoperative weight loss, mainly fat, could not all be accounted for by decreased caloric consumption or steatorrhea (72-h stool fat increased by a mean of 30 g). Pulmonary studies showed no significant change in respiratory quotient, but a large decrease in both postoperative utilization of oxygen and the production of carbon dioxide. This may indicate an alternate, anaerobic, energy cycle utilization. Other statistically significant variables included a large fall in cholesterol, LDH cholesterol and triglycerides, and smaller decrease in HDL cholesterol. Changes in gastro-intestinal (GI) hormones and cell counts in stomach and small intestine were also measured and will be reported later.
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