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Lund, Sweden

Arvidsson A.,Aleris Obesity Academy | Evertsson I.,Aleris Obesity Academy | Ekelund M.,Skane University Hospital | Gislason H.G.,Aleris Obesity Academy | And 3 more authors.
Obesity Surgery

Background: Bariatric patients seeking information meet very different recommendations on postoperative diet and eating behaviour. A reason for variability may be lack of hard evidence. A national survey on current dietary advice was conducted to serve as background for the present study on how drinking during a meal influenced caloric consumption.Methods: A standardised questionnaire was sent to all units in the Scandinavian Obesity surgery registry (SOReg) in order to obtain information regarding current diet advice after gastric bypass. Twenty-eight patients, 14 in each group, were studied either 2 months or 1 year after a standard gastric bypass (GBP). A standardised lunch was served on two separate days with or without water in randomised order. Meal and water weights were measured before and after. Hunger/satiety scores were obtained using visual analogue scales.Results: Response rate for surgeons was low, for dieticians 75 %. No clear consensus for liquid intake during meals was found; few surgeons advised patients whether or not to drink with meals. All patients ate to full satiety. Two months post-GBP, 7/14 patients consumed more solid food when allowed drinking water; the increase in caloric consumption was not significant. One year post-GBP, 5/14 patients consumed more solid food when allowed drinking water, the difference not reaching statistical significance.Conclusion: Our study does not indicate that patients should refrain from drinking during meals the first year after a GBP, at least not from a caloric intake point of view. © 2014, Springer Science+Business Media New York. Source

Karlsson A.,Aleris Obesity Academy | Wendel K.,Aleris Obesity Academy | Polits S.,Aleris Obesity Academy | Gislason H.,Aleris Obesity Academy | And 2 more authors.
Obesity Surgery

Background: Many patients experience postoperative nausea and vomiting (PONV). Preoperative treatment with carbohydrate solutions seems to improve the course after different types of surgery. This study was undertaken to investigate the potential value of different models for preoperative hydration/nutrition, in addition to our ERAS (enhanced recovery after surgery) protocol. Methods: Ninety non-diabetic women planned for elective laparoscopic gastric bypass and aged 18–65 years were included. All were on preoperative low-calorie diet (LCD). They were randomized into three arms, either a carbohydrate-rich drink, a protein-enriched drink, or tap water and instructed to drink 800 and 200 mL 16 and 2 h, respectively, prior to operation. Risk factors for PONV were recorded preoperatively. All patients were operated before lunch and received 1500–2000 mL of Ringer-Acetate solution during the 24–30-h postoperative hospital time. Four variables (nausea, pain, tiredness, and headache) were registered on 100-mm visual analog scales six times over 22 h. The need for additional medication was registered. Results: Out of 90 patients, 73 complete datasets were obtained. Nausea peaked at 7 p.m. but with no statistically significant differences between groups for any of the variables. Pain peaked the first 2 h postoperatively, remained longer, and had not returned to baseline values at 6 a.m. the morning after surgery but with no difference between groups. Conclusions: Inside our ERAS protocol, additional preoperative carbohydrate- or protein-enriched fluid treatment did not further reduce immediate patient discomfort in laparoscopic gastric bypass surgery. © 2015, Springer Science+Business Media New York. Source

Nordin L.,Aleris Obesity Academy | Nordlund A.,Aleris Obesity Academy | Lindqvist A.,Lund University | Gislason H.,Aleris Obesity Academy | And 2 more authors.
Journal of Gastrointestinal Surgery

Background: Postoperative nausea and vomiting (PONV) is common after general anaesthesia, and corticosteroids are used in many protocols for enhanced recovery after surgery (ERAS). However, surgical techniques are developing, and ERAS protocols need to be reevaluated from time to time. Patients and method: In this study, we compared the effects of oral vs. parenteral corticosteroid administration on postoperative nausea. Elective Roux-y-gastric bypass (RYGB) patients were randomly assigned to either 8 mg betamethasone orally (n = 50) or parentally (n = 25) or as controls (n = 25), in a double-blind design. PONV risk factors were noted. All patients had the same anaesthetic technique. Data were collected at baseline, on arrival to the recovery room (RR) and at five more time points during the first 24 h. Nausea and tiredness were patient assessed using visual analogue scales; rescue drug consumption was recorded. Results: Operation time was 30–40 min. Neither demographics nor risk factors for nausea differed between groups. Neither peak values for nor total amount of nausea differed between groups. The number of supplemental injections was the same for all groups. Comments: In a setting of modern laparoscopic RYGB, the value of betamethasone in preventing PONV seems to be limited. ERAS protocols may need re-evaluation. © 2016, The Society for Surgery of the Alimentary Tract. Source

Caesar Y.,Aleris Obesity Academy | Sidlovskaja I.,Aleris Obesity Academy | Lindqvist A.,Lund University | Gislason H.,Aleris Obesity Academy | And 2 more authors.
Obesity Surgery

Background: High intraabdominal pressure (IAP) during laparoscopic surgery has been associated with postoperative discomfort. Effects on nausea and access have not been subjected to randomized studies. In cholecystectomy, lower IAP may cause less pain, but nausea and surgical access in RYGB surgery have not been investigated. We studied the influence of two IAP levels on surgical access, operation time, postoperative pain, and nausea. Methods: Fifty consecutive female gastric bypass patients were randomized to intraabdominal pressure of 12 (IAP12) or 18 (IAP18) mm Hg. Surgeons and personnel were blinded to randomization; study groups were well matched for age and BMI. Operative time was noted in minutes. Visual analogue scales were used for assessing access and for patients assessing pain (abdomen-shoulder) and nausea (supine-standing) at six time points during the first 16 postoperative hours. Rescue medication was recorded. Results: In 3/25 patients in the IAP12 group, the code was broken due to access problems vs. 0/25 in the IAP18 group (p = 0.1398). Operative time did not differ. Access was significantly better for IAP18 (92.2 ± 2.3 vs. 69.3 ± 4.2; p = 0.0001). Postoperative shoulder pain was maximal after 6 h but throughout less than in the abdomen (p < 0.0001); there were no differences in pain between IAP18 and IAP12 (p = 0.7408). Postoperative nausea was significantly greater standing than supine but without differences between groups. Conclusion: Higher IAP gives better surgical access in laparoscopic Roux-en-Y gastric bypass with no negative effect on pain or nausea. © 2016 Springer Science+Business Media New York Source

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