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A prospective randomized clinical trial was undertaken to compare the effects of gastric bypass with Roux-en-Y gastrojejunostomy and a gastric partitioning procedure. Operative groups were comparable, with regard to preoperative weight, age, sex, historic findings and operative complications. Post-operative weight loss was followed for one year. Patients receiving the gastric partitioning procedure showed significantly poorer weight loss as early as three months postoperatively than did those receiving gastric bypass. This poorer performance persisted throughout the study period.

Presents the presidential address at the 66th Annual Scientific Meeting and Postgraduate Course Programs, Southeastern Surgical Congress in Atlanta, Georgia held January 31-February 4, 1998 concerning contributions made by Alabama surgeons in the field of heart injury repair. Reports originating in Alabama that were cited; Mechanisms of death; Management issues.

All surgeons will encounter difficult cholecystectomies. Many trying and untenable situations can be prevented or made easier by the cautious surgeon who has a carefully thought-out plan for each potential problem. Step-by-step, this article addresses the arduous challenges that may be faced beginning with diagnosis and continuing through the operative procedure including the decision to operate, the best intervention, abdominal entry, dealing with common duct stones, intraoperative cholangiography, exposure of the biliary anatomy, avoidance of bleeding or common duct injury, spilled stones, and postoperative bile collection. Each problem is addressed with emphasis on prevention and management. [ABSTRACT FROM AUTHOR]

Morbid obesity (MO) is associated with diabetes mellitus-type II (DM-II). Roux-en Y gastric bypass (RNY) has been shown to normalize glucose intolerance in these patients through an incompletely understood mechanism. Gastrointestinal hormonal changes have been suggested as an explanation for resolution of DM II. Preoperatively, 20 MO patients with DM-II were evaluated for demographics and fasting levels of the following: glucose, insulin, C-peptide, glucagon, cortisol, gastric inhibitory polypeptide (GIP), and glucagon-like peptide-1 (GLP-1). Each patient underwent RNY with a 15-cc gastric pouch and 150-cm Roux limb. Postoperatively, each of the variables was measured at 2 Weeks, 6 weeks, and 12 weeks and compared with the preoperative result using Student t test with significance, P = 0.05. Results are expressed as mean ± SD. Twenty patients (5 male and 15 female), age 40.3 ± 7.9 years, weight 146.3 ± 34.0 kg, height 158.7 ± 18.7 cm, and BMI 52.7 ± 8.8, were enrolled in this IRB-approved protocol. Weight and BMI decreased progressively (117.5 ± 26.9 kg and 47.0 ± 7.4, P = 0.01, respectively) during the study but reached significance only at 12 weeks. Fasting plasma glucose decreased significantly within 2 weeks after RNY. Insulin and cortisol both approached, but never achieved, significant changes over 12 weeks. GLP-1 increased initially, but not significantly. GIP and C-peptide both decreased significantly. Glucagon remained essentially unchanged over 12 weeks. RNY rapidly normalizes fasting plasma glucose in morbidly obese patients with DM-II. GIP, a gactor in the enteroinsulin axis, decreases and may play a role in the correction of DM-II after gastric bypass. [ABSTRACT FROM AUTHOR]

Video controlled laparoscopy has dramatically changed general surgery. Further striking alteration is sure to occur in the immediate future. Not only are the surgeons who are concentrating on this area making great strides, but innovative equipment and technological innovation are certain to make more complex procedures feasible. Thus the future of laparoscopic surgery is very bright.