Surgery News - December 2008 - (Page 15) DECEMBER 2008 • SURGERY NEWS GENERAL SURGERY 15 Gastric Bypass May Lessen Urinary Incontinence B Y J E F F E VA N S Else vier Global Medical Ne ws N A T I O N A L H A R B O R , M D . — Laparoscopic Roux-en-Y gastric bypass appears to rapidly resolve urinary incontinence in morbidly obese women, according to a recent prospective study. The results reinforce the importance of weight as a modifiable risk factor for urinary incontinence (UI), said Dr. Arthur M. Carlin, an ACS Fellow and research director of the bariatric surgery program at Henry Ford Hospital, Detroit. Of a total of 470 morbidly obese patients seeking bariatric surgery, UI occurred in 309 (66%), and in most of those, symptoms improved or resolved by 3 months after surgery by shedding just 30 pounds, Dr. Carlin reported at the annual meeting of the American Society for Metabolic and Bariatric Surgery. Patients in the study filled out the In- ternational Consultation on Incontinence Questionnaire Short Form (ICIQ-SF)— a validated, self-administered, one-page questionnaire—at the initial preoperative visit and at 3 and 12 months after surgery. In 58 of the women who underwent laparoscopic Roux-en-Y gastric bypass and completed a follow-up questionnaire, the mean total symptom score on the ICIQSF improved significantly from 7.6 at baseline to 3 at 3 months and to 1.8 at 12 months. These 58 women had UI defined by stress (33%), urge (21%), or a mixture of both (46%). UI had resolved in 54% of these women at 3 months and in 64% at 12 months. When improvement was also included, these rates became 84% and 92%, respectively. No one had worsening UI symptoms 12 months after surgery. “Our recommendation therefore is that laparoscopic gastric bypass should be considered an option for treating symptoms of urinary incontinence, especially in women with other comorbidities,” Dr. Carlin said. However, many urethral sling procedures are simpler to perform and involve less complication risk than gastric bypass, said Dr. Badrinath Konety, who commented on the study. “One should perhaps first manage the obesity with options like gastric bypass to determine if the incontinence can be resolved once significant weight reduction occurs. If there is persistent incontinence, they can seek other local therapeutic options such as some form of urethral suspension,” advised Dr. Konety, an ACS Fellow and associate professor in the department of urology at the University of California, San Francisco. ■ Poor Ergonomics Laparoscopic Surgeons • from page 1 need to study further the ergonomics of the perioperative environment, and the surgeon-patient and the surgeon-equipment interface.” Dr. Park said the response rate was a bit under 30%. The average age of respondents was 44.3 years, and 83% were male. On average they had been in practice for 9.8 years, and they performed 212 laparoscopic procedures annually. Surgeons with high caseloads were significantly more likely to report physical symptoms than were those who reported low caseloads. Right-handed surgeons were significantly more likely to report right-hand symptoms than left-hand symptoms (54% versus 40%). But lefthanded and ambidextrous surgeons showed no significant differences in symptoms between left and right hands. More than 80% of the symptoms occurred during or right after a case, but about 15% of surgeons said their symptoms were persistent. Little work has been done to identify which surgical movements are causing the problems, but Dr. Park speculated that differing degrees of freedom (about 20 in open surgery vs. 4-6 in laparoscopic surgery) and range of view (three-dimensional in open vs. two-dimensional in laparoscopic) may be contributing factors. Laparoscopic surgeons enjoy less tactile feedback than open surgeons, and laparoscopic instruments provide less force transmission than open instruments. And the “fulcrum effect,” which requires the surgeon to move the instrument handle in the direction opposite from the desired direction of the instrument tip, may also play a role. “I’ve practiced minimally invasive surgery my entire career. I’ve already had one wrist operated on, and I’m waiting for the next wrist to be operated on,” he said. He disclosed that he has relationships with Stryker Endoscopy, Surgiquest Inc., Apollo Endosurgery Inc., and W. L. Gore & Associates. ■ http://www.surgitel.com http://www.surgitel.com
Table of Contents Feed for the Digital Edition of Surgery News - December 2008 Surgery News - December 2008 Contents The 20/20 Vision: Health Reform News From the College: Nominations Thoracic: Breathing Easier Postop Management: Renal Failure Surgery News - December 2008 Surgery News - December 2008 - Contents (Page 1) Surgery News - December 2008 - Contents (Page 2) Surgery News - December 2008 - Contents (Page 3) Surgery News - December 2008 - Contents (Page 4) Surgery News - December 2008 - Contents (Page 5) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 6) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 7) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 8) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 9) Surgery News - December 2008 - News From the College: Nominations (Page 10) Surgery News - December 2008 - News From the College: Nominations (Page 11) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 12) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 13) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 14) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 15) Surgery News - December 2008 - Postop Management: Renal Failure (Page 16) Surgery News - December 2008 - Postop Management: Renal Failure (Page 17) Surgery News - December 2008 - Postop Management: Renal Failure (Page 18) Surgery News - December 2008 - Postop Management: Renal Failure (Page 19) Surgery News - December 2008 - Postop Management: Renal Failure (Page 20)
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