Bariatric Times - June 2008 - (Page 21) Bariatric Times • June 2008 Surgical Perspective 21 In a randomized prospective trial, STAPLE LINE REINFORCEMENT was shown to reduce staple site bleeding, decrease blood loss, and possibly reduce the incidence of gastrointestinal hemorrhage.9 Other hemostatic agents, SUCH AS FIBRIN SEALANT PLACED AROUND THE ANASTOMOSIS, may allow surgeons to achieve better hemostasis.10 early reduction in the hematocrit, and presentation within 6 to 12 hours after the procedure generally signify active surgical bleeding. In contrast, delayed gastrointestinal (GI) evacuation of old blood clots that have accumulated following the primary procedure generally do not represent active bleeding.2,4,11 The diagnosis of intraabdominal, extraluminal bleeding may be elusive and manifest as a decreasing hemotocrit and hemodynamic compromise without overt GI symptoms. Common sites of extraluminal postoperative bleeding include the mesentery surrounding the jejunojejunostomy, perigastric tissue, and the splenic area near the angle of His. The diagnosis is driven by clinical parameters, such as persistently large bloody output from drains, along with tachycardia, hypotension, oliguria, and a decreasing hematocrit.1 Previous studies cited drain output as one indicator of extraluminal bleeding, but it is important to note that none relied on this data alone to make the diagnosis or guide therapy, and some authors question the usefulness of a surgical drain. In a recent series of 352 consecutive LRYGB cases by Dallal, et al.,12 in which drains were not routinely placed, six patients had clinically significant bleeding (5 from GI tract). All cases were manifested by tachycardia and treated successfully with transfusion. Dallal, et al., therefore concluded that clinical indicators for bleeding were obvious without the additional data from a drain.12 Furthermore, even proponents of drains note that clotted drains may fail to alert potential active bleeding, giving a false sense http://www.protherabariatrics.com
Table of Contents Feed for the Digital Edition of Bariatric Times - June 2008 Bariatric Times - June 2008 Endoluminal Treatment Options for Morbid Obesity: Devices and Techniques for Natural Orifice Approaches The Multidisciplinary Approach to Weight Loss: Defining the Roles of the Necessary Providers Acute Bleeding after Gastric Bypass Editorial Message Contents ASMBS: 25 Years Editorial Board Surgical Site Infection In The Morbidly Obese Patient: A Review Consultant's Corner The Link Between Sleep Loss and Obesity: Understanding the Mechanisms Responsible for Weight Gain with Sleep Deprivation Volume Matters Journal Watch Advertiser Index Bariatric Times - June 2008 Bariatric Times - June 2008 - Acute Bleeding after Gastric Bypass (Page 1) Bariatric Times - June 2008 - Acute Bleeding after Gastric Bypass (Page 2) Bariatric Times - June 2008 - Editorial Message (Page 3) Bariatric Times - June 2008 - Contents (Page 4) Bariatric Times - June 2008 - Contents (Page 5) Bariatric Times - June 2008 - ASMBS: 25 Years (Page 6) Bariatric Times - June 2008 - Editorial Board (Page 7) Bariatric Times - June 2008 - Editorial Board (Page 8) Bariatric Times - June 2008 - Editorial Board (Page 9) Bariatric Times - June 2008 - Editorial Board (Page 10) Bariatric Times - June 2008 - Editorial Board (Page 11) Bariatric Times - June 2008 - Editorial Board (Page 12) Bariatric Times - June 2008 - Editorial Board (Page 13) Bariatric Times - June 2008 - Editorial Board (Page 14) Bariatric Times - June 2008 - Editorial Board (Page 15) Bariatric Times - June 2008 - Editorial Board (Page 16) Bariatric Times - June 2008 - Editorial Board (Page 17) Bariatric Times - June 2008 - Editorial Board (Page 18) Bariatric Times - June 2008 - Editorial Board (Page 19) Bariatric Times - June 2008 - Editorial Board (Page 20) Bariatric Times - June 2008 - Editorial Board (Page 21) Bariatric Times - June 2008 - Editorial Board (Page 22) Bariatric Times - June 2008 - Editorial Board (Page 23) Bariatric Times - June 2008 - Editorial Board (Page 24) Bariatric Times - June 2008 - Editorial Board (Page 25) Bariatric Times - June 2008 - Editorial Board (Page 26) Bariatric Times - June 2008 - Editorial Board (Page 27) Bariatric Times - June 2008 - Editorial Board (Page 28) Bariatric Times - June 2008 - Editorial Board (Page 29) Bariatric Times - June 2008 - Surgical Site Infection In The Morbidly Obese Patient: A Review (Page 30) Bariatric Times - June 2008 - Surgical Site Infection In The Morbidly Obese Patient: A Review (Page 31) Bariatric Times - June 2008 - Surgical Site Infection In The Morbidly Obese Patient: A Review (Page 32) Bariatric Times - June 2008 - Surgical Site Infection In The Morbidly Obese Patient: A Review (Page 33) Bariatric Times - June 2008 - Consultant's Corner (Page 34) Bariatric Times - June 2008 - Consultant's Corner (Page 35) Bariatric Times - June 2008 - The Link Between Sleep Loss and Obesity: Understanding the Mechanisms Responsible for Weight Gain with Sleep Deprivation (Page 36) Bariatric Times - June 2008 - The Link Between Sleep Loss and Obesity: Understanding the Mechanisms Responsible for Weight Gain with Sleep Deprivation (Page 37) Bariatric Times - June 2008 - The Link Between Sleep Loss and Obesity: Understanding the Mechanisms Responsible for Weight Gain with Sleep Deprivation (Page 38) Bariatric Times - June 2008 - The Link Between Sleep Loss and Obesity: Understanding the Mechanisms Responsible for Weight Gain with Sleep Deprivation (Page 39) Bariatric Times - June 2008 - Volume Matters (Page 40) Bariatric Times - June 2008 - Volume Matters (Page 41) Bariatric Times - June 2008 - Volume Matters (Page 42) Bariatric Times - June 2008 - Volume Matters (Page 43) Bariatric Times - June 2008 - Journal Watch (Page 44) Bariatric Times - June 2008 - Journal Watch (Page 45) Bariatric Times - June 2008 - Advertiser Index (Page 46) Bariatric Times - June 2008 - Advertiser Index (Page 47) Bariatric Times - June 2008 - Advertiser Index (Page 48)
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