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Gustavsson, Sven
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Publications (9 of 9) Show all publications
Hedberg, J., Gustavsson, S. & Sundbom, M. (2012). Long-term follow-up in patients undergoing open gastric bypass as a revisional operation for previous failed restrictive procedures. Surgery for Obesity and Related Diseases, 8(6), 696-701
Open this publication in new window or tab >>Long-term follow-up in patients undergoing open gastric bypass as a revisional operation for previous failed restrictive procedures
2012 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 8, no 6, p. 696-701Article in journal (Refereed) Published
Abstract [en]

Background

We have previously described our early experience with Roux-en-Y gastric bypass (RYGB) as a revisional procedure. The favorable results have stimulated us to continue using RYGB as our standard operating procedure after failed bariatric surgery. Our objective was to evaluate the perioperative risks, weight result, and abdominal symptoms 5 years after revisional RYGB surgery at a university hospital in Sweden.

Methods

We studied 121 patients undergoing revisional open RYGB (age 42.0 yr, body mass index 37.7 kg/m2, 101 women) 5 years after RYGB surgery. The patients underwent reoperation because of either intolerable side effects or inferior weight loss. The initial procedures were horizontal gastroplasty (n = 2), vertical banded gastroplasty (n = 34), gastric banding (n = 21), and silicone adjustable gastric banding (n = 64). The mean interval between the first surgery and revision was 5 years. The 5-year follow-up data were obtained annually using a questionnaire survey.

Results

The average operating time was 162 minutes (range 75–355). In these 121 cases, 10 (8%) reoperations were performed in the first 30-day period (4 for leakage). No perioperative mortality occurred, and the 5-year follow-up rate was 91%. The mean body mass index was 30.7 kg/m2. Seven patients (5.7%) had undergone subsequent surgery because of complications. At follow-up, 93% reported being very satisfied or satisfied with the revisional procedure. Disturbing abdominal symptoms after RYGB were rare.

Conclusion

The perioperative risks of revisional RYGB are greater than those for primary RYGB. However, because the long-term weight results and patient satisfaction are very good, we believe that the 8% reoperative rate is acceptable. We consider RYGB to be a suitable procedure for patients in whom previous bariatric procedures have failed.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-173036 (URN)10.1016/j.soard.2011.06.011 (DOI)000311919800007 ()21865097 (PubMedID)
Available from: 2012-04-18 Created: 2012-04-18 Last updated: 2018-06-08Bibliographically approved
Reinius, H., Jonsson, L., Gustafsson, S., Sundbom, M., Duvernoy, O., Pelosi, P., . . . Fredén, F. (2009). Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis: a computerized tomography study. Anesthesiology, 111(5), 979-987
Open this publication in new window or tab >>Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis: a computerized tomography study
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2009 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 111, no 5, p. 979-987Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Morbidly obese patients show impaired pulmonary function during anesthesia and paralysis, partly due to formation of atelectasis. This study analyzed the effect of general anesthesia and three different ventilatory strategies to reduce the amount of atelectasis and improve respiratory function. METHODS: Thirty patients (body mass index 45 +/- 4 kg/m) scheduled for gastric bypass surgery were prospectively randomized into three groups: (1) positive end-expiratory pressure of 10 cm H2O (PEEP), (2) a recruitment maneuver with 55 cm H2O for 10 s followed by zero end-expiratory pressure, (3) a recruitment maneuver followed by PEEP. Transverse lung computerized tomography scans and blood gas analysis were recorded: awake, 5 min after induction of anesthesia and paralysis at zero end-expiratory pressure, and 5 min and 20 min after intervention. In addition, spiral computerized tomography scans were performed at two occasions in 23 of the patients. RESULTS: After induction of anesthesia, atelectasis increased from 1 +/- 0.5% to 11 +/- 6% of total lung volume (P < 0.0001). End-expiratory lung volume decreased from 1,387 +/- 581 ml to 697 +/- 157 ml (P = 0.0014). A recruitment maneuver + PEEP reduced atelectasis to 3 +/- 4% (P = 0.0002), increased end-expiratory lung volume and increased Pao2/Fio2 from 266 +/- 70 mmHg to 412 +/- 99 mmHg (P < 0.0001). PEEP alone did not reduce the amount of atelectasis or improve oxygenation. A recruitment maneuver + zero end-expiratory pressure had a transient positive effect on respiratory function. All values are presented as mean +/- SD. CONCLUSIONS: A recruitment maneuver followed by PEEP reduced atelectasis and improved oxygenation in morbidly obese patients, whereas PEEP or a recruitment maneuver alone did not.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-113069 (URN)10.1097/ALN.0b013e3181b87edb (DOI)000271172500009 ()19809292 (PubMedID)
Available from: 2010-01-25 Created: 2010-01-25 Last updated: 2017-12-12Bibliographically approved
Siilin, H., Wanders, A., Gustavsson, S. & Sundbom, M. (2005). The proximal gastric pouch invariably contains acid-producing parietal cells in Roux-en-Y gastric bypass.. Obes Surg, 15(6), 771-7
Open this publication in new window or tab >>The proximal gastric pouch invariably contains acid-producing parietal cells in Roux-en-Y gastric bypass.
2005 (English)In: Obes Surg, ISSN 0960-8923, Vol. 15, no 6, p. 771-7Article in journal (Refereed) Published
Keywords
Adult, Female, Gastric Bypass/adverse effects/*methods, Gastric Mucosa/*cytology, Humans, Male, Parietal Cells; Gastric/cytology, Stomach Ulcer/prevention & control, Suture Techniques
Identifiers
urn:nbn:se:uu:diva-80616 (URN)15978145 (PubMedID)
Available from: 2006-05-18 Created: 2006-05-18 Last updated: 2011-01-11
Ljungdahl, M., Eriksson, L.-G., Nyman, R. & Gustavsson, S. (2004). Artärembolisering kan ofta ersätta kirurgi vid blödande ulkus: När endoskopisk hemostas inte lyckas behövs alternativ akut behandling. Läkartidningen, 101(9), 768-772
Open this publication in new window or tab >>Artärembolisering kan ofta ersätta kirurgi vid blödande ulkus: När endoskopisk hemostas inte lyckas behövs alternativ akut behandling
2004 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, no 9, p. 768-772Article in journal (Refereed) Published
Keywords
Aged, Duodenal Ulcer/complications, Embolization; Therapeutic/*methods, Emergencies, English Abstract, Female, Hemostasis; Endoscopic, Humans, Male, Peptic Ulcer Hemorrhage/radiography/surgery/*therapy, Stomach Ulcer/complications, Treatment Outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-73055 (URN)15045840 (PubMedID)
Available from: 2005-09-26 Created: 2005-09-26 Last updated: 2017-12-14Bibliographically approved
Gustavsson, S. & Westling, A. (2002). Laparoscopic adjustable gastric banding: complications and side effects responsible for the poor long-term outcome. Seminars in Laparoscopic Surgery, 9(2), 115-124
Open this publication in new window or tab >>Laparoscopic adjustable gastric banding: complications and side effects responsible for the poor long-term outcome
2002 (English)In: Seminars in Laparoscopic Surgery, ISSN 1071-5517, E-ISSN 1532-8694, Vol. 9, no 2, p. 115-124Article in journal (Refereed) Published
Abstract [en]

In a remarkably short time, Laparoscopic Adjustable Gastric Banding (LAGB) has become a common operation for morbid obesity in Europe and elsewhere. More than 70,000 such procedures have been performed in recent years. We used LAGB as a routine treatment for morbid obesity in 90 patients between 1994 and 1996. We agree with other authors that LAGB is the least invasive of all gastric restrictive procedures, resulting in a low perioperative mortality and morbidity. The weight loss appears to be similar to that obtained by vertical banded gastroplasty (VBG). However, our long-term follow-up studies, including endoscopic examinations, as well as recent data in the literature also indicate a number of significant problems with LAGB. Patient discomfort occurs frequently in the postoperative course. When questioned according to a standardized protocol 2 years after surgery, every other patient in our series admitted heartburn and acid regurgitation. Regular endoscopic surveillance revealed a prevalence of erosive esophagitis of 44%. After a median follow-up of 7 years, 58% of the patients had been reoperated on, almost always with excision of the banding system and conversion to Roux-en-Y gastric bypass (RYGBP). The reasons for reoperation were esophagitis, band erosion, pouch dilatation, leakage from the balloon, and esophageal dilatation, complications that also have been described in several recent papers in the literature. Our prediction is that LAGB will not stand the test of time.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-190180 (URN)12152154 (PubMedID)
Available from: 2013-01-07 Created: 2013-01-07 Last updated: 2017-12-06Bibliographically approved
Westling, A., Öhrvall, M. & Gustavsson, S. (2002). Roux-en-Y gastric bypass after previous unsuccessful gastric restrictive surgery. Journal of Gastrointestinal Surgery, 6(2), 206-211
Open this publication in new window or tab >>Roux-en-Y gastric bypass after previous unsuccessful gastric restrictive surgery
2002 (English)In: Journal of Gastrointestinal Surgery, ISSN 1091-255X, E-ISSN 1873-4626, Vol. 6, no 2, p. 206-211Article in journal (Refereed) Published
Abstract [en]

In the treatment of morbid obesity, simple gastric restrictive methods such as silicone adjustable gastric banding, vertical banded gastroplasty, and nonadjustable gastric banding often fail to control weight in the long run or give rise to intolerable side effects. Here we review our results from conversion of such failures to Roux-en-Y gastric bypass. The study comprised 44 patients (median age 42 years, range 24 to 60 years) who underwent revision surgery in 1996 and 1997. Body mass index at revision was 35 kg/m2 (range 21 to 49 kg/m2). Previous bariatric procedures included silicone adjustable gastric banding (n = 26), vertical banded gastroplasty (n = 13), and gastric banding (n = 5). The most common reasons for conversion after silicone adjustable gastric banding and nonadjustable gastric banding were band erosion (n = 12) and esophagitis (n = 11). Staple line disruption (n = 12) with subsequent weight loss failure was the primary cause after vertical banded gastroplasty. There were no postoperative deaths or anastomotic leaks. One patient underwent reexploration because of an infected hematoma. Reflux symptoms and vomiting resolved promptly. At global assessment 2 years later, 70% of the patients were very satisfied. Median body mass index had decreased to 28 kg/m2 (range 18 to 42 kg/m2). No patient was lost to follow-up. As reported previously, failure after vertical gastric banding can be treated by conversion to Roux-en-Y gastric bypass with good results. In this study we found that failure after silicone adjustable gastric banding can be treated successfully with Roux-en-Y gastric bypass as well.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-200225 (URN)10.1016/S1091-255X(01)00035-X (DOI)11992806 (PubMedID)
Available from: 2013-05-23 Created: 2013-05-23 Last updated: 2017-12-06Bibliographically approved
Westling, A. & Gustavsson, S. (2001). Laparoscopic vs open Roux-en-Y gastric bypass: a prospective randomized trial. Obesity Surgery, 11(3), 284-292
Open this publication in new window or tab >>Laparoscopic vs open Roux-en-Y gastric bypass: a prospective randomized trial
2001 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 11, no 3, p. 284-292Article in journal (Refereed) Published
Abstract [en]

Background:

The feasibility of laparoscopic Roux-en-Y gastric bypass (Lap-RYGBP) for morbid obesity is well documented. In a prospective randomized trial, we compared laparoscopic and open surgery.

Methods:

51 patients (48 females, mean (± SD) age 36 ± 9 years and BMI 42 ± 4 kg/m2) were randomly allocated to either laparoscopy (n=30) or open surgery (n=21). All patients were followed for a minimum of 1 year.

Results:

In the laparoscopy group, 7 patients (23%) were converted to open surgery due to various procedural difficulties. In an analysis, with the converted patients excluded, the morphine doses used postoperatively were significantly (p< 0.005) lower in the laparoscopic group compared to the open group. Likewise, postoperative hospital stay was shorter (4 vs 6 days, p<0.025). Six patients in the laparoscopy group had to be re-operated due to Roux-limb obstruction in the mesocolic tunnel within 5 weeks. The weight loss expressed in decrease in mean BMI units after year was 14 and 13 after 1 ± 3 ± 3 laparoscopy and open surgery,respectively (not significant).

Conclusions:

Both laparoscopic and open RYGBP are effective and well received surgical procedures in morbid obesity. Reduced postoperative pain, shorter hospital stay and shorter sick-leave are obvious benefits of laparoscopy but conversions and/or reoperations in 1/4 of the patients indicate that Lap-RYGBP at present must be considered an investigational procedure.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-190185 (URN)10.1381/096089201321336610 (DOI)11433902 (PubMedID)
Available from: 2013-01-07 Created: 2013-01-07 Last updated: 2017-12-06Bibliographically approved
Westling, A., Bjurling, K., Öhrvall, M. & Gustavsson, S. (1998). Silicone-adjustable gastric banding: disappointing results. Obesity Surgery, 8(4), 467-474
Open this publication in new window or tab >>Silicone-adjustable gastric banding: disappointing results
1998 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 8, no 4, p. 467-474Article in journal (Refereed) Published
Abstract [en]

Background:

Silicone-adjustable Gastric banding (SAGB) has been popularized as a minimally invasive, completely reversible surgical treatment for morbid obesity. We report here out 3-year experience of SAGB with special reference to complications and side-effects.

Methods:

There were 90 patients in total, of whom 72 were women. Median age was 42 (range, 20-68) years and median body mass index (BMI) was 43 (range, 34-57) kg/m2. Laparoscopy was attempted to position the band in 63 cases but had to be converted to laparotomy in 16 (25%). Twenty-seven patients were laparotomized. We used the Swedish band (AB Obtech) throughout the series. In addition to regular clinic visits, patients were followed-up with upper gastrointestinal series 6 months postoperatively and gastroscopy after 2 years or earlier when symptomatic.

Results:

Median BMI decreased to 32 kg/m2 after 12 months and to 31 kg/m2 after 24 months. With a median follow-up time of 35 months (range, 22-48), 32 patients (35%) have been re-operated usually with removal of the balloon system and conversion into a Roux-en-Y gastric bypass. The most common reasons for re-operation were band erosion (n = 10) and erosive esophagitis (n = 14). Additional indications for re-operation included pouch dilatation, invagination of distal gastric wall through the band, leakage from the balloon, patient dissatisfaction, and severe allergic reaction. When questioned 2 years postoperatively more than half of the patients reported vomiting, heartburn and regurgitation but 78% still pronounced themselves satisfied with the operation. Esophagitis was found in 56% of the patients at gastroscopy after 2 years.

Conclusion:

SAGB could be positioned with laparoscopy in 75% of the cases but the incidence of complications and side-effects postoperatively has been high.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-190186 (URN)10.1381/096089298765554386 (DOI)9731684 (PubMedID)
Available from: 2013-01-07 Created: 2013-01-07 Last updated: 2017-12-06Bibliographically approved
Sundbom, M. & Gustavsson, S. Hand-assisted laparoscopic versus open Roux-en-Y gastric bypass: a prospective, randomised study.
Open this publication in new window or tab >>Hand-assisted laparoscopic versus open Roux-en-Y gastric bypass: a prospective, randomised study
(English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-90561 (URN)
Available from: 2003-04-28 Created: 2003-04-28 Last updated: 2013-08-15Bibliographically approved
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