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| News and Notes
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Laparoscopic adjustable gastric banding is a safe and effective weight-loss measure for adolescents, say researchers at the New York University School of Medicine. The study, published in the January issue of the Journal of Pediatric Surgery and the first to measure the efficacy of lap band surgery in patients under the age of 17, notes the procedure resulted in a 50 percent loss of excess weight in teen patients at one year and 18-month post-op exams.
The study's authors reviewed post-op results of 53 teenagers aged 13 years to 17 years who underwent outpatient lap band surgery at the NYU Medical Center, one of three facilities in the United States approved by the FDA to study lap band use in adolescent patients. Of the 53 patients, 41 were women, the mean pre-op weight was 297 pounds and the average body mass index was 47.6.
None of the patients suffered complications that required admission to the hospital, although two patients experienced slippage of the band, two patients developed hiatal hernias and one patient suffered a post-op wound infection. The study's lead author, Evan Nadler, MD, director of Pediatric Minimally Invasive Surgery and Assistant Professor of Surgery at New York University School of Medicine, says none of the patients regained any of the lost weight.
"This study suggests that the lap band provides a safer and equally effective weight loss strategy compared to the gastric bypass," says Dr. Nadler. "This is good news for parents contemplating obesity surgery for their adolescent children."
While the study's authors say lap band surgery is the optimal surgical choice for morbidly obese pediatric patients, other bariatric surgeons caution against that unqualified assertion, noting that the NYU study did not directly compare gastric bypass to the lap band procedure and that the patients' long-term weight loss results have yet to be realized.
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| Lap Band Surgery Shows Effective Short-term Results in Teens
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Laparoscopic adjustable gastric banding is a safe and effective weight-loss measure for adolescents, say researchers at the New York University School of Medicine. The study, published in the January issue of the Journal of Pediatric Surgery and the first to measure the efficacy of lap band surgery in patients under the age of 17, notes the procedure resulted in a 50 percent loss of excess weight in teen patients at one year and 18-month post-op exams.
The study's authors reviewed post-op results of 53 teenagers aged 13 years to 17 years who underwent outpatient lap band surgery at the NYU Medical Center, one of three facilities in the United States approved by the FDA to study lap band use in adolescent patients. Of the 53 patients, 41 were women, the mean pre-op weight was 297 pounds and the average body mass index was 47.6.
None of the patients suffered complications that required admission to the hospital, although two patients experienced slippage of the band, two patients developed hiatal hernias and one patient suffered a post-op wound infection. The study's lead author, Evan Nadler, MD, director of Pediatric Minimally Invasive Surgery and Assistant Professor of Surgery at New York University School of Medicine, says none of the patients regained any of the lost weight.
"This study suggests that the lap band provides a safer and equally effective weight loss strategy compared to the gastric bypass," says Dr. Nadler. "This is good news for parents contemplating obesity surgery for their adolescent children."
While the study's authors say lap band surgery is the optimal surgical choice for morbidly obese pediatric patients, other bariatric surgeons caution against that unqualified assertion, noting that the NYU study did not directly compare gastric bypass to the lap band procedure and that the patients' long-term weight loss results have yet to be realized.
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| Overweight, Obese Kids at Higher Risk of Surgical Problems
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The nearly one-third of pediatric patients who are overweight or obese have a greater chance of experiencing surgical complications, even after common surgical procedures, according to a study in the January issue of the Journal of the National Medical Association.
Researchers at the University of Michigan Health System reviewed a database of all 6,017 pediatric surgeries conducted at the UM hospital between 2000 and 2004 and found that 31.5 percent were overweight or obese, with more than half of those children qualifying as obese.
Just as overweight adult patients are more likely to develop infections in their wounds after surgery, so too are overweight children, who are increasingly likely to have conditions such as Type II diabetes, hypertension, asthma and respiratory difficulties, say the researchers. Further, they suggest that overweight and obese children have an increased likelihood of requiring certain types of surgery, such as the removal of tonsils and adenoids as well as other surgeries to resolve breathing problems and sleep apnea, orthopedic surgeries to repair broken bones and connective tissue, and digestive and gastrointestinal fixes.
"The high rates of overweight and obesity that we found among children are striking because overweight children have a higher risk of problems before, during and after surgery," says lead author Bukky Nafiu, MD, FRCA, a resident in the UM Medical School Department of Anesthesiology.
While all age ranges in the study involved high rates of overweight and obesity, the highest was in boys and girls aged 8 to 12 years, which "seems to indicate an age-related vulnerability to becoming overweight and needing surgery, and this is something we believe warrants further studies," says Dr. Nafiu.
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| Study: Two-minute Pre-op Chat Can Block Surgical Errors
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You've heard of the surgical timeout, a pause immediately before incision during which you identify and verify the patient, surgical site, procedure and position at hand. Now comes the two-minute briefing, a meeting during which all members of the OR team state their name and role, while the lead surgeon identifies and verifies the critical components of the operation.
A study of Johns Hopkins Hospital's surgeons, anesthesiologists and nurses suggests that hospital policies requiring a brief pre-op team meeting to make sure surgery is performed on the right patient and the right part of the body could decrease errors. The briefing is performed after anesthesia is administered and before incision.
In the study, which will appear in the February issue of the Journal of the American College of Surgeons, Hopkins OR personnel were "very positive" about the briefings, says surgeon Martin Makary, MD, MPH, director of the Johns Hopkins Center for Surgical Outcomes Research and lead author of the study.
"Although we lack systems for uniform reporting of wrong-site surgeries to understand the extent of the problem, we observed that team meetings increase the awareness of OR personnel with regard to the site and procedure and their perceptions of operating rooms' safety," says Dr. Makary in a prepared statement.
A standardized OR briefing program became Hopkins policy in June 2006. Before the new policy was implemented, many surgeons would walk into the OR and start working without a conversation of any kind and without even knowing the names of the nurses and other staff who were assisting them, says Dr. Makary.
A survey of 147 surgeons, 59 anesthesiologists, 187 nurses and 29 other OR staff was conducted twice, once before implementing the policy and once after it had been in effect for three months. After training, the number of personnel who believed the policy would be an effective one increased by 13.2 percent, while more than 90 percent agreed with the statement that "a team discussion before a surgical procedure is important for patient safety."
"The Joint Commission identified communication breakdowns as the most common root cause of wrong-site surgeries," says Dr. Makary in his statement. "Our research indicates that OR personnel see pre-surgical briefings as a useful tool to help prevent such errors."
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