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10/10/2016 0 Comments Owners manual, connection diagram for Alpine 7. R and 3. 90. 0 D/A needed - SQ & Technical. Thank you ! This is already helpful. If someone have Alpine 5. S and 3. 55. 8 and don't find any use for them, please let me know.. The 5. 95. 9s = some of them usually crop up on e. Bay every once or so..Class A amp is as rare as me having 6 girls knocking on my door coated in syrup.. Most of their manuals date back to the early 9. Thats where I got the 3. Goto Tech Centre > Consumer site and search for 7.R' is for the european models )Failing that phone Alpine direct on 0.View, read and download owner's manual for ALPINE 3558, learn how to repair it, fix failures or solve other issues. Owner's Manual for ALPINE 3558, downloadable as a PDF file. We also have service manual to this model. Manual details Immediate download after payment. Designed by ALPINE Japan 68-21627Z84-A . ALPINE ELECTRONICS OF.Find great deals on eBay for alpine 3522 amp. Download PDF file with ALPINE 3558 Service Manual. Available translations: EN. Have You lost manual for Your appliance? Come visit us, We have largest library of consumer electronics manuals. Description of ALPINE 3558 Service Manual Complete service. 10/10/2016 0 Comments Young Artist Program, Robotics, Young Scientists, Character Lessons, iPads and Technology, Cooking Classes, Theme Days. Follow City of Phoenix on. Information City Checkbook Proposed T axes & Fees Phoenix City. City of Phoenix > Parks and Recreation > Classes and Programs. Classes and Programs. 374 Recreation Jobs available in Phoenix. Sun City, AZ (3) Surprise, AZ (3) Recreation jobs. The Salvation Armys Fleet Safety program on an annual basis. For more information about Tempe's Summer Camps. Escalante Summer Kamp Kool Program. K-5th grade camps meet in several locations throughout the City of.Phoenix Public Library.Teen Volunteers. Teens. Are you between 1. Teens assist staff with Summer and Winter Reading Programs and other special projects throughout the year. Teens typically help with shelving, storytime programming and give general support related to the Youth Services Department. Contribute something unique and lend a hand at your local library. Join the library team of teen volunteers! Information on becoming a teen summer volunteer will be available Spring 2.Open Hires allow applicants to apply and interview for Rec-PAC summer.Take a peek at Phoenix's summer. 10/10/2016 0 Comments Windows Power. Shell/Loops - Wikiversity. This lesson introduces Power. Shell loops, including condition- based while and do while/do until loops, counter- based for loops, and collection- based foreach loops.Objectives and Skills. For example: for($i=0; $i- lt. Start by asking the user how many scores they would like to enter. Then use a loop to request each score and add it to a total. Finally, calculate and display the average for the entered scores.You can use the routines in these programs as though they are built-in parts of the EViews programming. Miller's Fortran Examples. FORTRAN 77 subroutines and functions are not allowed to call themselves directly. Subroutines and Functions. A complex and large computer program can be broken up into many more manageable subprograms. There is only one 'main' program, the other. XComputerLab 3: Subroutines. Like loops and decisions, subroutines are useful in the.Revise the script several times to compare the code required when the loop control structure is based on while, do while, do until, and for statements, respectively. Review Maths. Is. Fun: 1. 0x Printable Multiplication Table.Create a script that uses nested for loops to generate a multiplication table. Rather than simply creating a 1. Review Maths. Is. Fun: 1. 0x Printable Multiplication Table. Create a script that uses nested for loops to generate a multiplication table. Use a condition with (< variable> % 2) to test for odd or even values.Generate the multiplication table only for even values. For odd values, use the continue statement to continue the next iteration of the loop. Review Maths. Is. Fun: 1. 0x Printable Multiplication Table. Create a script that uses nested for loops to generate a multiplication table.Rather than simply creating a 1. Use a break statement to terminate the loop if the count exceeds 1. Create a script that retrieves a list of all services and then uses foreach to display the names of all running services. While this could also be done using Select- Object, there are times when processing objects is faster and easier using foreach. Review Microsoft Tech. Net: Using the Start- Sleep Cmdlet. Write a script that uses an infinite loop to call the Get- Counter cmdlet every sixty seconds.Redirect the Get- Counter output and append it to a file. Run the script for a few minutes and then check the file contents to observe system utilization. Lesson Summary. All control flow must be structured using conditions, loops. Control flow refers to . Control flow statement types include .Computer Mc68000 Cpu Programming Program Loops And Subroutines - Visit us for both offline and online computer programming training options, schools. If many programmers are working on a single program, subroutines are. Infinite loops are used to assure a program. A variety of control-flow. For Loop Iteration Demonstrates the use of a for() loop. Lights multiple LEDs in sequence, then in reverse. The circuit: * LEDs from pins 2 through 7 to ground.Power. Shell does not support . All control flow must be structured using . All control flow must be structured using conditions, loops, functions (subroutines), or exit (unconditional halt).Fortran subroutines and functions. Functions; Modifying arguments; The use of intent; Subroutines. Here the program and function are in the same file.Power. Shell uses curly braces to . Loop structures include . While and do while/do until are . Loops may be continued prematurely using . Loops may be terminated prematurely using .Scripts may be terminated prematurely using . The For. Each- Object cmdlet . The Start- Sleep cmdlet .The Get- Counter cmdlet . 10/10/2016 0 Comments Write the Cesar Cipher in C. You want to be able to hang out with the cool kids that use the Caesar Cipher.Program Everyday Written by Dan Sackett on January 1. Continuing on from yesterday, I wanted to introduce the Caesar cipher and give an example of how to implement it in Python. Much like the substitution cipher from yesterday's post, the Caesar cipher transforms the alphabet creating a mapping from keys to different values making it act much like a substitution cipher.Where it differs however is how we generate this new key. Instead of randomizing our keys and reassigning them as values, the Caesar cipher simply rotates the alphabet to the right. For instance: A == B. So now when we are encrypting plaintext, we simply substitute our values and we're done. As we can see, this process is very primitive in nature and way less secure than a typical substitution cipher. In fact, an attack on this cipher is quite easy. We can do a short brute force attack trying each rotation of the alphabet until we see a plaintext message that makes sense.Implementing Caesar Cipher in C. It's really only necessary to use printf() for formatted output. Caesar Cipher program in C.Playfair cipher is a draft. OUTPUT: ===== BM OD ZB. Caesar cipher You are encouraged to solve.Once we do, we have our key thanks to the rotation being uniform across the set. The primitive nature of this cipher is due to its namesake. It was Julius Caesar who encrypted all of his messages this way it seems. He was famous for a simple single rotation key which at the time was very hard to understand. This was mostly due to the lack of educated people in the world. As Caesar passed messages, those that didn't understand believed that it was another language and carried on.While smart for the time, I'll reiterate that this is one of the fastest ciphers to solve. Still, it doesn't hurt to see it in action as it can be a fun puzzle. ATTACKATDAWN. alpha = ABCDEFGHIJKLMNOPQRSTUVWXYZ.BCDEFGHIJKLMNOPQRSTUVWXYZA. BUUBDLBUEBXO. As we see, we shifted our alphabet once and use our key to substitute the new letters to create our ciphertext. If you're a math person, we have a simple formula that can help you determine the new letter as well: Given x is the current letters index in regards to our alphabet and n is the rotation.E(x) = (x + n) % 2. D(x) = (x - n) % 2. With this algorithm, we can build ourselves a simple script in Python that will encrypt and decrypt our data for us: key='abcdefghijklmnopqrstuvwxyz'defencrypt(n,plaintext). We then build our encryption function which is a little more advanced than a single word scheme. In this example, I'm checking if the value exists in our alphabet and if it doesn't then I want to simply output that character instead of the encrypted character. This will allow us to use punctuation, space, etc.We apply our algorithm to each letter of the plaintext and return a new concatenated string as our ciphertext. To decrypt it, we simply do the opposite (subtracting the rotation) and we get our message back. We can run the program and see an example here: show. We then get: Rotation: 5. Plaintext: the grass is always greener.Encrytped: ymj lwfxx nx fqbfdx lwjjsjw. Decrytped: the grass is always greener. This works! As we can see, this is very easy to implement which also shows how easy it really is to break as well. For those that don't want to write a program to do this, there is a Caesar cipher provided in the standard library in Python called rot. Be warned though as this is only supported in Python 2.Seeing how the Caesar cipher works, I hope you'll come back tomorrow to understand how the Vigenere cipher works which actually is many Caesar ciphers chained together. As with the last post, you can checkout some crypto stuff (including code) in a Github repo. I'll leave you with a special message which is encoded in the Caesar cipher I've provided. Let me know what the message says and where it's from ; )comments powered by. 10/10/2016 0 Comments Video Atlas of Advanced Minimally Invasive Surgery - 9. Minimally Invasive Video- Assisted Thyroidectomy. Video- Assisted Thoracoscopic Lobectomy.Operative Atlas of Laparoscopic Reconstructive Urology. 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Minimally Invasive Pediatric Procedures. Complications of Peritoneal Access. The Radiology Of Minimally Invasive Abdominal Surgery. Surgical Robotics. New Minimally Invasive Surgery Technology. 10/10/2016 0 Comments FRITZDSL Startcenter for Windows. FRITZDSL Startcenter (avm- berlin. Windows software application that has been discovered and submitted by users of Software. Alle Rechte vorbehalten.FRITZDSL Startcenter 1. Windows. FRITZDSL Startcenter (avm- berlin. Windows software application that has been discovered and submitted by users of Software. Alle Rechte vorbehalten.Ab sofort steht das aktuelle FRITZ!OS 6.50 f Avm Fritz Dsl, free avm fritz dsl software downloads. Home; Search WinSite; Browse WinSite; HotFiles@WinSite. Avm Fritz Download; Fritz Dsl Screenshots. Bekannt ist AVM vor allem durch die Produktreihen FRITZ.FRITZDSL Startcenter (avm-berlin.fritzdsl-startcenter.stcenter) is a Windows software application that has been discovered and submitted by. 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Miss Metro St Louis Scholarship Program Source Page: 10/10/2016 0 Comments Edmonton's Best Rock : : Janis Joplin : : Featured Artist was also a great blues singer, making her material her own with her wailing, raspy, supercharged emotional delivery. First rising to stardom as the frontwoman for San Francisco psychedelic band , she left the group in the late '6. Although she wasn't always supplied with the best material or most sympathetic musicians, her best recordings, with both and on her own, are some of the most exciting performances of her era.Find information about 'Janis Joplin' listen to 'Janis Joplin' on AllMusic. Very Best of Janis Joplin. Playlist: The Very Best of Janis Joplin. Janis Joplin Greatest Hits . Subscribe Subscribed Unsubscribe 135 135. The Very Best of Janis Joplin - Duration: 1:49:09.She also did much to redefine the role of women in rock with her assertive, sexually forthright persona and raunchy, electrifying on- stage presence. She'd been singing blues and folk music since her teens, playing on occasion in the mid- '6. Jefferson Airplane guitarist Jorma Kaukonen. There are a few live pre- Big Brother recordings (not issued until after her death), reflecting the inspiration of early blues singers like Bessie Smith, that demonstrate she was well on her way to developing a personal style before hooking up with the band. She had already been to California before moving there permanently in 1. San Francisco psychedelic group, Big Brother & the Holding Company. Although their loose, occasionally sloppy brand of bluesy psychedelia had some charm, there can be no doubt that Joplin - - who initially didn't even sing lead on all of the material - - was primarily responsible for lifting them out of the ranks of the ordinary.She made them a hit at the 1. Monterey Pop Festival, where her stunning version of . After a debut on the Mainstream label, Big Brother signed a management deal with Albert Grossman and moved on to Columbia.Their second album, Cheap Thrills, topped the charts in 1. Joplin left the band shortly afterward, enticed by the prospects of stardom as a solo act. Joplin's first album, I Got Dem Ol' Kozmic Blues Again Mama!, was recorded with the Kozmic Blues Band, a unit that included horns and retained just one of the musicians that had played with her in Big Brother (guitarist Sam Andrew). Although it was a hit, it wasn't her best work; the new band, though more polished musically, was not nearly as sympathetic accompanists as Big Brother, purveying a soul- rock groove that could sound forced. That's not to say it was totally unsuccessful, boasting one of her signature tunes in . Musically, however, things were on the upswing shortly before her death, as she assembled a better, more versatile backing outfit, the Full Tilt Boogie Band, for her final album, Pearl (ably produced by Paul Rothchild).Joplin was sometimes criticized for screeching at the expense of subtlety, but Pearl was solid evidence of her growth as a mature, diverse stylist who could handle blues, soul, and folk- rock. Tragically, she died before the album's release, overdosing on heroin in a Hollywood hotel in October 1. 10/10/2016 0 Comments List of postal codes in Austria. Austrian postal code areas. Postal codes in Austria consist of four digits. They were introduced on 1 January 1. Each code denotes a post office of the .The second identifies a routing area. The third defines the route the mail takes either with the car/truck or with the train. The fourth stands for the post office outlet in the routing city. Geographic delivery areas. There are some exceptions to this rule. For example, the market town of Weyer has a postal code of 3.Upper Austria and not in Lower Austria, as the postal code would suggest. However, it is served from a Lower Austrian mail distribution centre. The Styrian village of Tauchen am Wechsel, part of the Pinggau municipality has the Burgenlandian post code 7. Tauchen near Mariasdorf. In the Austrian capital Vienna, the second and third digit describe the district within the city (i. The Vienna International Airport, officially located in Schwechat, Lower Austria has its own postal code 1. Vienna International Centre (UNO City) in the Vienna Donaustadt district has the postal code 1.The post code 1. 50. Austrian Armed Forces.The municipalities of Mittelberg in Kleinwalsertal, Vorarlberg, and Jungholz, Tyrol have both Austrian and German postal codes, as they are served by the Deutsche Post company. Wolfgang, Upper Austria. Salzburg. 60. 00 - 6. Tyrol. 67. 00 - 6. Vorarlberg. 70. 00 - 7. Burgenland. 74. 21.Tauchen (Pinggau), Styria. Burgenland. 80. 00 - 8. Styria. 83. 80 - 8. Burgenland. 84. 01 - 8. Styria. 90. 00 - 9.Carinthia. 93. 23.Instantly get the Austria country code and Austrian area codes to help you make your international call to Austria. Our complete resource of area & country codes will help you make your call to Vienna and other Austrian cities. Search Airport/City Code Search airport/city code by: 1. Zip code 22031 statistics: (Find on map) Estimated zip code population in 2013: 31,329 Zip code population in 2010: 29,795. City-data.com does not guarantee the accuracy or timeliness of any information on this site.Lookup Austria Postal Code/Zip Code/Postcode of Address, Place & Cities in Austria. Austria Postal Code Map will display the nearby searched postal codes. This is an online tool (Mashup) to search postal code of a place, address or city in Austria. This is the Austria postcode website, including more than 894 items of area, city, region and zip code etc. Zip Codes & Postal Codes of the World Country Zip Code Albania - Albania - Posta Shqiptare (PDF) Algeria - Algeria - Le Code Postal Argentina Postal codes -Argentina Postal codes - Correo Argentino. City of Vienna, WV covers 1 Area Code 304 Area Code City of Vienna, WV covers 1 Zip Code 26105 Zip Code 21 Cities within 15 Miles of the City of Vienna, WV Barlow,OH Belmont,WV Belpre,OH Cutler,OH Davisville,WV Fleming,OH Little Hocking.City of Vienna, VA - FAIRFAX County Virginia ZIP Codes. Detailed information on every zip code in Vienna. ZIP-Codes.com Products ZIP Code Database Get all US ZIP Codes and their information in one easy to use database. ZIP+4 ZIP Code Database. City informations of Wien, latitude, longitude, map and postcode / zip code of Wien 1230. Empire and the archduchy of Austria, the Empire of Austria 1804-1866 and later of the dual monarchy, commonly known as Austria-Hungary 1867-1918. 10/10/2016 0 Comments Malware - Malicious Virus Code Detection - Trojan - Trojan Horse. Malware is a category of malicious code that includes viruses, worms, and Trojan horses. Destructive malware will utilize popular communication tools to spread, including worms sent through email and instant messages, Trojan horses dropped from web sites, and virus- infected files downloaded from peer- to- peer connections.Malware will also seek to exploit existing vulnerabilities on systems making their entry quiet and easy.Cleaning, the efficient way. Emsisoft Anti-Malware is fueled by a dual engine malware scanner for twice the malware cleaning power, with no extra resource requirements. What are malware, viruses, Spyware, and cookies, and what differentiates them?Write something about yourself. No need to be fancy, just an overview. 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To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video Published byJoseph McLaughlin Modified over 2 years ago 1 { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://images.slideplayer.com/15/4734772/slides/slide_2.jpg", "name": "", "description": "", "width": "800" } 2 Case 1: A 45-year-old woman c/o of acute retrosternal pain with dorsal radiation Past Medical History (+) for HTN, DMII, dyslipidemia Past Surgical History: 2 x C/S had undergone LAGB (Laparoscopic Adjustable Gastric Banding) for morbid obesity at another hospital 3 years previously; current BMI is approximately 35 { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/2/Case+1%3A+A+45-year-old+woman+c%2Fo+of+acute+retrosternal+pain+with+dorsal+radiation.+Past+Medical+History+%28%2B%29+for+HTN%2C+DMII%2C+dyslipidemia..jpg", "name": "Case 1: A 45-year-old woman c/o of acute retrosternal pain with dorsal radiation. Past Medical History (+) for HTN, DMII, dyslipidemia.", "description": "Past Surgical History: 2 x C/S. had undergone LAGB (Laparoscopic Adjustable Gastric Banding) for morbid obesity at another hospital 3 years previously; current BMI is approximately 35.", "width": "800" } 3 Super-Sized in the ED: Bariatric Surgery ComplicationsScott Bicek University of Calgary March 1,2007 { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/3/Super-Sized+in+the+ED%3A+Bariatric+Surgery+Complications.jpg", "name": "Super-Sized in the ED: Bariatric Surgery Complications", "description": "Scott Bicek. University of Calgary. March 1,2007.", "width": "800" } 4 Objectives: Obesity epidemiology Overview of bariatric surgeriesComplications of bariatric surgery ED scenarios { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/4/Objectives%3A+Obesity+epidemiology+Overview+of+bariatric+surgeries.jpg", "name": "Objectives: Obesity epidemiology Overview of bariatric surgeries", "description": "Complications of bariatric surgery. ED scenarios.", "width": "800" } 5 Measuring Obesity BMI (Body Mass Index) = (body mass)/(height)2 = kg/m2 Canadian Standards < 18.5 = Underweight 18.5 to 24.9 = Normal weight 25.0 to =Overweight   ≥ 30.0 = Obese { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/5/Measuring+Obesity+BMI+%28Body+Mass+Index%29+%3D+%28body+mass%29%2F%28height%292+%3D+kg%2Fm2.+Canadian+Standards.+%3C+18.5+%3D+Underweight..jpg", "name": "Measuring Obesity BMI (Body Mass Index) = (body mass)/(height)2 = kg/m2. Canadian Standards. < 18.5 = Underweight.", "description": "18.5 to 24.9 = Normal weight. 25.0 to 29.9 =Overweight ≥ 30.0 = Obese.", "width": "800" } 6 Obesity Trends Among Canadian and U.S. Adults, 1990No Data <10% %-14% % 20% Mokdad AH. Unpubliahed Data. Katzmarzyk PT. Can Med Assoc J 2002;166: { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/6/Obesity+Trends+Among+Canadian+and+U.S.+Adults%2C+1990.jpg", "name": "Obesity Trends Among Canadian and U.S. Adults, 1990", "description": "No Data 7 Obesity Trends Among Canadian and U.S. Adults, 1994No Data <10% %-14% % 20% Mokdad AH, et al. J Am Med Assoc 1999;282:16. Katzmarzyk PT. Can Med Assoc J 2002;166: { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/7/Obesity+Trends+Among+Canadian+and+U.S.+Adults%2C+1994.jpg", "name": "Obesity Trends Among Canadian and U.S. Adults, 1994", "description": "No Data 8 Obesity Trends Among Canadian and U.S. Adults, 1996No Data <10% %-14% % 20% Mokdad AH, et al. J Am Med Assoc 1999;282:16. Katzmarzyk PT. Can Med Assoc J 2002;166: { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/8/Obesity+Trends+Among+Canadian+and+U.S.+Adults%2C+1996.jpg", "name": "Obesity Trends Among Canadian and U.S. Adults, 1996", "description": "No Data 9 Obesity Trends Among Canadian and U.S. Adults, 1998No Data <10% %-14% % 20% Mokdad AH, et al. J Am Med Assoc 1999;282:16. Katzmarzyk PT. Can Med Assoc J 2002;166: { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/9/Obesity+Trends+Among+Canadian+and+U.S.+Adults%2C+1998.jpg", "name": "Obesity Trends Among Canadian and U.S. Adults, 1998", "description": "No Data 10 Obesity Trends Among Canadian and U.S. Adults, 2000No Data <10% %-14% % 20% Mokdad AH, et al. J Am Med Assoc 2000;284:13. Statistics Canada. Health Indicators, May, 2002. { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/10/Obesity+Trends+Among+Canadian+and+U.S.+Adults%2C+2000.jpg", "name": "Obesity Trends Among Canadian and U.S. Adults, 2000", "description": "No Data 11 Obesity Trends Among Canadian and U.S. Adults, 2003No Data <10% %-14% % 20% Sources: Behavioral Risk Factor Surveillance System, CDC Statistics Canada. Health Indicators, June, 2004. { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/11/Obesity+Trends+Among+Canadian+and+U.S.+Adults%2C+2003.jpg", "name": "Obesity Trends Among Canadian and U.S. Adults, 2003", "description": "No Data 12 Medical Complications of ObesityPulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Idiopathic intracranial hypertension Stroke Cataracts Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Coronary heart disease Diabetes Dyslipidemia Hypertension Gall bladder disease Severe pancreatitis Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Medical complication of obesity Osteoarthritis Phlebitis venous stasis Skin Gout { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/12/Medical+Complications+of+Obesity.jpg", "name": "Medical Complications of Obesity", "description": "Pulmonary disease. abnormal function. obstructive sleep apnea. hypoventilation syndrome. Idiopathic intracranial hypertension. Stroke. Cataracts. Nonalcoholic fatty liver disease. steatosis. steatohepatitis. cirrhosis. Coronary heart disease. Diabetes. Dyslipidemia. Hypertension. Gall bladder disease. Severe pancreatitis. Gynecologic abnormalities. abnormal menses. infertility. polycystic ovarian syndrome. Cancer. breast, uterus, cervix. colon, esophagus, pancreas. kidney, prostate. Medical complication of obesity. Osteoarthritis. Phlebitis. venous stasis. Skin. Gout.", "width": "800" } 13 Bariatric Surgery In 2001, approximately 30,000 weight loss procedures were performed in the U.S increased to approximately 60,000 in 2003 increase in bariatric surgery has also been fueled in part by the application of laparoscopic techniques { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/13/Bariatric+Surgery+In+2001%2C+approximately+30%2C000+weight+loss+procedures+were+performed+in+the+U.S.+increased+to+approximately+60%2C000+in+2003..jpg", "name": "Bariatric Surgery In 2001, approximately 30,000 weight loss procedures were performed in the U.S. increased to approximately 60,000 in 2003.", "description": "increase in bariatric surgery has also been fueled in part by the application of laparoscopic techniques.", "width": "800" } 14 { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://images.slideplayer.com/15/4734772/slides/slide_15.jpg", "name": "", "description": "", "width": "800" } 15 { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://images.slideplayer.com/15/4734772/slides/slide_16.jpg", "name": "", "description": "", "width": "800" } 16 { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://images.slideplayer.com/15/4734772/slides/slide_17.jpg", "name": "", "description": "", "width": "800" } 17 Vertical Banded Gastroplasty { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/17/Vertical+Banded+Gastroplasty.jpg", "name": "Vertical Banded Gastroplasty", "description": "Vertical Banded Gastroplasty", "width": "800" } 18 Vertical Banded Gastroplastypurely restrictive procedure A small pouch is made along the lesser curvature of the stomach using surgical staplers { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/18/Vertical+Banded+Gastroplasty.jpg", "name": "Vertical Banded Gastroplasty", "description": "purely restrictive procedure. A small pouch is made along the lesser curvature of the stomach using surgical staplers.", "width": "800" } 19 Vertical Banded Gastroplastypurely restrictive procedure A small pouch is made along the lesser curvature of the stomach using surgical staplers { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/19/Vertical+Banded+Gastroplasty.jpg", "name": "Vertical Banded Gastroplasty", "description": "purely restrictive procedure. A small pouch is made along the lesser curvature of the stomach using surgical staplers.", "width": "800" } 20 Vertical Banded Gastroplastypurely restrictive procedure A small pouch is made along the lesser curvature of the stomach using surgical staplers A nonadjustable band then constricts the outlet from the pouch { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/20/Vertical+Banded+Gastroplasty.jpg", "name": "Vertical Banded Gastroplasty", "description": "purely restrictive procedure. A small pouch is made along the lesser curvature of the stomach using surgical staplers. A nonadjustable band then constricts the outlet from the pouch.", "width": "800" } 21 Vertical Banded Gastroplastypurely restrictive procedure A small pouch is made along the lesser curvature of the stomach using surgical staplers A nonadjustable band then constricts the outlet from the pouch { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/21/Vertical+Banded+Gastroplasty.jpg", "name": "Vertical Banded Gastroplasty", "description": "purely restrictive procedure. A small pouch is made along the lesser curvature of the stomach using surgical staplers. A nonadjustable band then constricts the outlet from the pouch.", "width": "800" } 22 Vertical Banded GastroplastyProcedure relies on reduced food intake to achieve weight loss patients tend to lose approximately 50% of excess weight during the first 2 years postprocedure (Edwards et al., 2006) Longterm follow-up of patients has revealed that it is not an extremely effective weight loss surgery { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/22/Vertical+Banded+Gastroplasty.jpg", "name": "Vertical Banded Gastroplasty", "description": "Procedure relies on reduced food intake to achieve weight loss. patients tend to lose approximately 50% of excess weight during the first 2 years postprocedure (Edwards et al., 2006) Longterm follow-up of patients has revealed that it is not an extremely effective weight loss surgery.", "width": "800" } 23 Vertical Banded Gastroplastypatients who undergo a vertical banded gastroplasty circumvent this restrictive procedure by eating soft, high-calorie foods { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/23/Vertical+Banded+Gastroplasty.jpg", "name": "Vertical Banded Gastroplasty", "description": "patients who undergo a vertical banded gastroplasty circumvent this restrictive procedure by eating soft, high-calorie foods.", "width": "800" } 24 Laparoscopic Adjustable Gastric Banding (LAP-BAND) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/24/Laparoscopic+Adjustable+Gastric+Banding+%28LAP-BAND%29.jpg", "name": "Laparoscopic Adjustable Gastric Banding (LAP-BAND)", "description": "Laparoscopic Adjustable Gastric Banding (LAP-BAND)", "width": "800" } 25 LAP-BAND the restrictive procedure of choiceadjustable silastic band that is positioned around the upper portion of the stomach The band is connected to a port that is implanted under the skin { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/25/LAP-BAND+the+restrictive+procedure+of+choice.jpg", "name": "LAP-BAND the restrictive procedure of choice", "description": "adjustable silastic band that is positioned around the upper portion of the stomach. The band is connected to a port that is implanted under the skin.", "width": "800" } 26 LAP-BAND port is similar to those used for vascular access and allows the band to be tightened or loosened, depending on clinical need advantages over the vertical banded gastroplasty include: No surgical stapling of the stomach (decreased risk of perforation or fistula formation) Ability to regulate degree of restriction postoperatively relative ease for reversibility { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/26/LAP-BAND+port+is+similar+to+those+used+for+vascular+access+and+allows+the+band+to+be+tightened+or+loosened%2C+depending+on+clinical+need..jpg", "name": "LAP-BAND port is similar to those used for vascular access and allows the band to be tightened or loosened, depending on clinical need.", "description": "advantages over the vertical banded gastroplasty include: No surgical stapling of the stomach (decreased risk of perforation or fistula formation) Ability to regulate degree of restriction postoperatively. relative ease for reversibility.", "width": "800" } 27 Case 1: A 45-year-old woman who had undergone LAGB for morbid obesity at another hospital 3 years previously complains of acute retrosternal pain with dorsal radiation w/u completed to r/o MI and PE (ECG, Troponin, CT-PE – all normal) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/27/Case+1%3A+A+45-year-old+woman+who+had+undergone+LAGB+for+morbid+obesity+at+another+hospital+3+years+previously..jpg", "name": "Case 1: A 45-year-old woman who had undergone LAGB for morbid obesity at another hospital 3 years previously.", "description": "complains of acute retrosternal pain with dorsal radiation. w/u completed to r/o MI and PE (ECG, Troponin, CT-PE – all normal)", "width": "800" } 28 Case 1: Several hours after admission and only after insistent questioning did the patient mention the concomitant onset of severe food intolerance that she considered to be secondary to her chest pain Any other investigations you would like to order? { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/28/Case+1%3A.jpg", "name": "Case 1:", "description": "Several hours after admission and only after insistent questioning did the patient mention the concomitant onset of severe food intolerance that she considered to be secondary to her chest pain. Any other investigations you would like to order", "width": "800" } 29 Case 1: Gastrograffin swallow revealed strangulation of the stomach by the adjustable gastric banding device with dilatation of the upper gastric pouch (prolapse) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/29/Case+1%3A.jpg", "name": "Case 1:", "description": "Gastrograffin swallow revealed strangulation of the stomach by the adjustable gastric banding device with dilatation of the upper gastric pouch (prolapse)", "width": "800" } 30 Gastric Prolapse characterized by enlargement of the upper gastric pouch due to herniation of the fundus upward through the band Its incidence has decreased from 22% to 5% in recent years after modification in surgical technique and improved band adjustment protocols (Spivak and Faveretti, 2002) manifests by food intolerance, vomiting, regurgitation, heartburn, and epigastric pain { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/30/Gastric+Prolapse+characterized+by+enlargement+of+the+upper+gastric+pouch+due+to+herniation+of+the+fundus+upward+through+the+band..jpg", "name": "Gastric Prolapse characterized by enlargement of the upper gastric pouch due to herniation of the fundus upward through the band.", "description": "Its incidence has decreased from 22% to 5% in recent years after modification in surgical technique and improved band adjustment protocols (Spivak and Faveretti, 2002) manifests by food intolerance, vomiting, regurgitation, heartburn, and epigastric pain.", "width": "800" } 31 The band MUST be completely deflatedGastric Prolapse If the diagnosis is suspected (or confirmed late radiographically) what should your next step be? The band MUST be completely deflated { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/31/The+band+MUST+be+completely+deflated.jpg", "name": "The band MUST be completely deflated", "description": "Gastric Prolapse. If the diagnosis is suspected (or confirmed late radiographically) what should your next step be The band MUST be completely deflated.", "width": "800" } 32 Deflating the LAP-Band:The access port is usually situated in the LUQ either subcutaneously or under the anterior sheath of the rectus abdominis muscle In patients who have already lost weight, it can usually be palpated and stabilized between 3 fingers of the left hand using STERILE TECHNIQUE A 20 GA needle on a 10 cc syring held in the right hand penetrates the port membrane at its center { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/32/Deflating+the+LAP-Band%3A.jpg", "name": "Deflating the LAP-Band:", "description": "The access port is usually situated in the LUQ either subcutaneously or under the anterior sheath of the rectus abdominis muscle. In patients who have already lost weight, it can usually be palpated and stabilized between 3 fingers of the left hand using STERILE TECHNIQUE. A 20 GA needle on a 10 cc syring held in the right hand penetrates the port membrane at its center.", "width": "800" } 33 Deflating the LAP-Band:Proper positioning of the needle within the port chamber is attested by the tactile feeling of the needle tip hitting the metallic chamber floor and by spontaneous outflow of fluid The most commonly used model is the LAP-BAND 9.75 cm which can accommodate up to 5 mL of fluid (whereas other models contain as much as 9 mL) Can be done under fluoroscopy guidance { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/33/Deflating+the+LAP-Band%3A.jpg", "name": "Deflating the LAP-Band:", "description": "Proper positioning of the needle within the port chamber is attested by the tactile feeling of the needle tip hitting the metallic chamber floor and by spontaneous outflow of fluid. The most commonly used model is the LAP-BAND 9.75 cm which can accommodate up to 5 mL of fluid (whereas other models contain as much as 9 mL) Can be done under fluoroscopy guidance.", "width": "800" } 34 Case 1: After the diagnosis of gastric prolapse was made with the gastrograffin study, the LAP-band was successfully deflated (4 cc was extracted from the port) Urgent Surgical consult initiated Would you like any other investigations? { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/34/Case+1%3A.jpg", "name": "Case 1:", "description": "After the diagnosis of gastric prolapse was made with the gastrograffin study, the LAP-band was successfully deflated (4 cc was extracted from the port) Urgent Surgical consult initiated. Would you like any other investigations", "width": "800" } 35 Gastric Necrosis and Erosion:GI consult for URGENT gastroscopy because gastric necrosis and erosion has been demonstrated with gastric prolapse In one large study, gastric erosion occurred in 6.8% of patients in isolation (Suter et al., 2004) Patients may present with evidence of intra-abdominal sepsis caused by perforation with or without abscess, gastrocutaneous fistulas, and with ‘‘late’’ infection at the port site Treatment for this problem consists of surgical removal and repair of the gastric perforation { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/35/Gastric+Necrosis+and+Erosion%3A.jpg", "name": "Gastric Necrosis and Erosion:", "description": "GI consult for URGENT gastroscopy because gastric necrosis and erosion has been demonstrated with gastric prolapse. In one large study, gastric erosion occurred in 6.8% of patients in isolation (Suter et al., 2004) Patients may present with evidence of intra-abdominal sepsis caused by perforation with or without abscess, gastrocutaneous fistulas, and with ‘‘late’’ infection at the port site. Treatment for this problem consists of surgical removal and repair of the gastric perforation.", "width": "800" } 36 Complications After Laparoscopic Adjustable Gastric BandingStudy O’Brien [47] Belachew[50] Dargent[49] Vertruyen[51] Weiner[76] No. Patients 1120 763 500 543 184 Mortality  0 Postoperative complications 1.5 12.3 2.2 9 Slippage 13.9 8.0 5.0 4.6 Erosion 3 0.9 0.6 1.1 Port Complications 5.4 2.5 1.0 2.9 3.2 Reoperation Rate 25.3 10.5 6.6 4.2 6.4 Gastric Perforation 0.5 0.8 Pulmonary Embolism Wound Infection 0.1 All numbers except number of patients represent percentages. Townsend: Sabiston Textbook of Surgery, 17th ed. { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/36/Complications+After+Laparoscopic+Adjustable+Gastric+Banding.jpg", "name": "Complications After Laparoscopic Adjustable Gastric Banding", "description": "Study. O’Brien [47] Belachew[50] Dargent[49] Vertruyen[51] Weiner[76] No. Patients. 1120. 763. 500. 543. 184. Mortality. 0. Postoperative complications. 1.5. 12.3. 2.2. 9. Slippage. 13.9. 8.0. 5.0. 4.6. Erosion. 3. 0.9. 0.6. 1.1. Port Complications. 5.4. 2.5. 1.0. 2.9. 3.2. Reoperation Rate. 25.3. 10.5. 6.6. 4.2. 6.4. Gastric Perforation. 0.5. 0.8. Pulmonary Embolism. Wound Infection. 0.1. All numbers except number of patients represent percentages. Townsend: Sabiston Textbook of Surgery, 17th ed.", "width": "800" } 37 LAP-BAND: ComplicationsCumulative operative risks for the laparoscopic adjustable gastric band appear to be less than that for gastric bypass { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/37/LAP-BAND%3A+Complications.jpg", "name": "LAP-BAND: Complications", "description": "Cumulative operative risks for the laparoscopic adjustable gastric band appear to be less than that for gastric bypass.", "width": "800" } 38 { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://images.slideplayer.com/15/4734772/slides/slide_39.jpg", "name": "", "description": "", "width": "800" } 39 { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://images.slideplayer.com/15/4734772/slides/slide_40.jpg", "name": "", "description": "", "width": "800" } 40 Roux-en-Y Gastric Bypass { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/40/Roux-en-Y+Gastric+Bypass.jpg", "name": "Roux-en-Y Gastric Bypass", "description": "Roux-en-Y Gastric Bypass", "width": "800" } 41 Roux-en-Y Gastric Bypassmost commonly performed operation for morbid obesity in the U.S. (performed both open and laparoscopically) both a restrictive and subclinical malabsorptive procedure { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/41/Roux-en-Y+Gastric+Bypass.jpg", "name": "Roux-en-Y Gastric Bypass", "description": "most commonly performed operation for morbid obesity in the U.S. (performed both open and laparoscopically) both a restrictive and subclinical malabsorptive procedure.", "width": "800" } 42 Roux-en-Y Gastric Bypassa small proximal gastric pouch (15-30 ml) is made and is connected to the jejunum - a variable amount of proximal small bowel is bypassed { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/42/Roux-en-Y+Gastric+Bypass.jpg", "name": "Roux-en-Y Gastric Bypass", "description": "a small proximal gastric pouch (15-30 ml) is made and is connected to the jejunum - a variable amount of proximal small bowel is bypassed.", "width": "800" } 43 Roux-en-Y Gastric Bypassa small proximal gastric pouch (15-30 ml) is made and is connected to the jejunum - a variable amount of proximal small bowel is bypassed { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/43/Roux-en-Y+Gastric+Bypass.jpg", "name": "Roux-en-Y Gastric Bypass", "description": "a small proximal gastric pouch (15-30 ml) is made and is connected to the jejunum - a variable amount of proximal small bowel is bypassed.", "width": "800" } 44 Roux-en-Y Gastric Bypassa small proximal gastric pouch (15-30 ml) is made and is connected to the jejunum - a variable amount of proximal small bowel is bypassed { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/44/Roux-en-Y+Gastric+Bypass.jpg", "name": "Roux-en-Y Gastric Bypass", "description": "a small proximal gastric pouch (15-30 ml) is made and is connected to the jejunum - a variable amount of proximal small bowel is bypassed.", "width": "800" } 45 Is Roux-en-Y Gastric Bypass Effective?Comparing Roux-en-Y to laparoscopic adjustable gastric banding, it produces greater excess weight loss, 74.6% versus 40.4% at 18 months (Biertho et al., 2003) ...But is it safe? { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/45/Is+Roux-en-Y+Gastric+Bypass+Effective.jpg", "name": "Is Roux-en-Y Gastric Bypass Effective", "description": "Comparing Roux-en-Y to laparoscopic adjustable gastric banding, it produces greater excess weight loss, 74.6% versus 40.4% at 18 months (Biertho et al., 2003) ...But is it safe", "width": "800" } 46 Case 2: 45 year old, obese (BMI = 42) woman presents to the ED c/o feeling “feverish” and unwell x 12 hours Past Medical History is (+) DMII, knee OA (bilateral) Rou-en-Y gastric bypass performed in Medicine Hat 2 weeks earlier { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/46/Case+2%3A+45+year+old%2C+obese+%28BMI+%3D+42%29+woman+presents+to+the+ED+c%2Fo+feeling+feverish+and+unwell+x+12+hours..jpg", "name": "Case 2: 45 year old, obese (BMI = 42) woman presents to the ED c/o feeling feverish and unwell x 12 hours.", "description": "Past Medical History is (+) DMII, knee OA (bilateral) Rou-en-Y gastric bypass performed in Medicine Hat 2 weeks earlier.", "width": "800" } 47 Case 2: Vitals: T=37.9, HR=115, BP=110/65, RR=20Physical examination: very unremarkable { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/47/Case+2%3A+Vitals%3A+T%3D37.9%2C+HR%3D115%2C+BP%3D110%2F65%2C+RR%3D20.jpg", "name": "Case 2: Vitals: T=37.9, HR=115, BP=110/65, RR=20", "description": "Physical examination: very unremarkable.", "width": "800" } 48 Complications After Laparoscopic Roux-en-Y Gastric BypassStudy Schauer et al.[17] Higa et al.[33] Wittgrove and Clark[18] DeMaria et al.[69] Papasavas et al.[70] Gould et al.[80] Oliak et al.[81] No. Patients 275 1500 500 281 116 223 300 Mortality 0.36 0.2 0.86 1.0 Gastrointestinal Hemorrhage 1.1 1.7 Leak 4.4 0.9 2.2 5.1 2.6 1.8 1.3 Pulmonary Embolism 0.73 0.67 Small Bowel Obstruction 3.5 0.6 3.3 1.03 1.67 Stenosis 4.7 4.9 1.6 6.6 3.4 5.4 2.0 Wound Infection 8.7 0.13 5.6 7.6 6.67 Incisional Hernia 0.27 Marginal Ulcer Splenectomy Pneumonia 0.07 0.3 All numbers except number of patients represent percentages. Townsend: Sabiston Textbook of Surgery, 17th ed. { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/48/Complications+After+Laparoscopic+Roux-en-Y+Gastric+Bypass.jpg", "name": "Complications After Laparoscopic Roux-en-Y Gastric Bypass", "description": "Study. Schauer et al.[17] Higa et al.[33] Wittgrove and Clark[18] DeMaria et al.[69] Papasavas et al.[70] Gould et al.[80] Oliak et al.[81] No. Patients. 275. 1500. 500. 281. 116. 223. 300. Mortality. 0.36. 0.2. 0.86. 1.0. Gastrointestinal Hemorrhage. 1.1. 1.7. Leak. 4.4. 0.9. 2.2. 5.1. 2.6. 1.8. 1.3. Pulmonary Embolism. 0.73. 0.67. Small Bowel Obstruction. 3.5. 0.6. 3.3. 1.03. 1.67. Stenosis. 4.7. 4.9. 1.6. 6.6. 3.4. 5.4. 2.0. Wound Infection. 8.7. 0.13. 5.6. 7.6. 6.67. Incisional Hernia. 0.27. Marginal Ulcer. Splenectomy. Pneumonia. 0.07. 0.3. All numbers except number of patients represent percentages. Townsend: Sabiston Textbook of Surgery, 17th ed.", "width": "800" } 49 “The Big 3” Complications You Do NOT Want to Miss { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/49/The+Big+3+Complications+You+Do+NOT+Want+to+Miss.jpg", "name": "The Big 3 Complications You Do NOT Want to Miss", "description": "The Big 3 Complications You Do NOT Want to Miss", "width": "800" } 50 “The Big 3” Complications You Do Not Want to miss#1 ANASTOMOTIC LEAK #2 DVT or PE #3 BOWEL OBSTRUCTION (INTERNAL HERNIA) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/50/The+Big+3+Complications+You+Do+Not+Want+to+miss.jpg", "name": "The Big 3 Complications You Do Not Want to miss", "description": "#1 ANASTOMOTIC LEAK. #2 DVT or PE. #3 BOWEL OBSTRUCTION (INTERNAL HERNIA)", "width": "800" } 51 Any patient who presents in the first weeks after a Roux-en-Y with tachycardia and fever might be harboring an anastomotic leak with associated abscess { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/51/Any+patient+who+presents+in+the+first+weeks+after+a+Roux-en-Y+with+tachycardia+and+fever+might+be+harboring+an+anastomotic+leak+with+associated+abscess.jpg", "name": "Any patient who presents in the first weeks after a Roux-en-Y with tachycardia and fever might be harboring an anastomotic leak with associated abscess", "description": "Any patient who presents in the first weeks after a Roux-en-Y with tachycardia and fever might be harboring an anastomotic leak with associated abscess", "width": "800" } 52 Roux-en-Y Gastric BypassReported anastomotic leak rates are as high as 5.9% (Lujan JA et al., 2004) with the majority of these leaks occurring at the gastrojejunostomy { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/52/Roux-en-Y+Gastric+Bypass.jpg", "name": "Roux-en-Y Gastric Bypass", "description": "Reported anastomotic leak rates are as high as 5.9% (Lujan JA et al., 2004) with the majority of these leaks occurring at the gastrojejunostomy.", "width": "800" } 53 Roux-en-Y Gastric BypassReported anastomotic leak rates are as high as 5.9% (Lujan JA et al., 2004) with the majority of these leaks occurring at the gastrojejunostomy { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/53/Roux-en-Y+Gastric+Bypass.jpg", "name": "Roux-en-Y Gastric Bypass", "description": "Reported anastomotic leak rates are as high as 5.9% (Lujan JA et al., 2004) with the majority of these leaks occurring at the gastrojejunostomy.", "width": "800" } 54 Roux-en-Y Gastric BypassReported anastomotic leak rates are as high as 5.9% (Lujan JA et al., 2004) with the majority of these leaks occurring at the gastrojejunostomy Investigation of choice? { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/54/Roux-en-Y+Gastric+Bypass.jpg", "name": "Roux-en-Y Gastric Bypass", "description": "Reported anastomotic leak rates are as high as 5.9% (Lujan JA et al., 2004) with the majority of these leaks occurring at the gastrojejunostomy. Investigation of choice", "width": "800" } 55 Roux-en-Y Gastric Bypass: Anastomotic LeakCT scan of the abdomen and pelvis, preferably with oral and intravenous contrast limited size of the gastric pouch, it is neither feasible nor advisable to have a patient attempt to consume the usual 1 L of oral contrast patient should sip contrast during 3 hours and scan the patient regardless of the absolute volume consumed { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/55/Roux-en-Y+Gastric+Bypass%3A+Anastomotic+Leak.jpg", "name": "Roux-en-Y Gastric Bypass: Anastomotic Leak", "description": "CT scan of the abdomen and pelvis, preferably with oral and intravenous contrast. limited size of the gastric pouch, it is neither feasible nor advisable to have a patient attempt to consume the usual 1 L of oral contrast. patient should sip contrast during 3 hours and scan the patient regardless of the absolute volume consumed.", "width": "800" } 56 What if the patient is to heavy for the CT scanner?At the FMC the weight limit for the CT scanner is 400 lbs and MRI is 350 lbs If the possibility of an anastomotic leak exists and the patient is too heavy for CT, an upper GI series with a water-soluble agent should be obtained { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/56/What+if+the+patient+is+to+heavy+for+the+CT+scanner.jpg", "name": "What if the patient is to heavy for the CT scanner", "description": "At the FMC the weight limit for the CT scanner is 400 lbs and MRI is 350 lbs. If the possibility of an anastomotic leak exists and the patient is too heavy for CT, an upper GI series with a water-soluble agent should be obtained.", "width": "800" } 57 Early Complications: Anastomotic leak DVT and PEIntraabdominal bleeding { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/57/Early+Complications%3A+Anastomotic+leak+DVT+and+PE.jpg", "name": "Early Complications: Anastomotic leak DVT and PE", "description": "Intraabdominal bleeding.", "width": "800" } 58 GI Bleeding Develop bleeding from the staple lines at the gastrojejunostomy (most common), the jejunojejunostomy and even along the transected edge of the gastric remnant { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/58/GI+Bleeding.jpg", "name": "GI Bleeding", "description": "Develop bleeding from the staple lines at the gastrojejunostomy (most common), the jejunojejunostomy and even along the transected edge of the gastric remnant.", "width": "800" } 59 GI Bleeding Develop bleeding from the staple lines at the gastrojejunostomy (most common), the jejunojejunostomy and even along the transected edge of the gastric remnant { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/59/GI+Bleeding.jpg", "name": "GI Bleeding", "description": "Develop bleeding from the staple lines at the gastrojejunostomy (most common), the jejunojejunostomy and even along the transected edge of the gastric remnant.", "width": "800" } 60 GI Bleeding Develop bleeding from the staple lines at the gastrojejunostomy (most common), the jejunojejunostomy and even along the transected edge of the gastric remnant { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/60/GI+Bleeding.jpg", "name": "GI Bleeding", "description": "Develop bleeding from the staple lines at the gastrojejunostomy (most common), the jejunojejunostomy and even along the transected edge of the gastric remnant.", "width": "800" } 61 GI Bleeding Develop bleeding from the staple lines at the gastrojejunostomy (most common), the jejunojejunostomy and even along the transected edge of the gastric remnant { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/61/GI+Bleeding.jpg", "name": "GI Bleeding", "description": "Develop bleeding from the staple lines at the gastrojejunostomy (most common), the jejunojejunostomy and even along the transected edge of the gastric remnant.", "width": "800" } 62 GI Bleeding Management as per any GI bleedConsult GI for upper endoscopy to determine site of bleeding from the gastrojejunostomy Potential for surgery if site of bleeding not visualized, however most bleeding is self limited { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/62/GI+Bleeding+Management+as+per+any+GI+bleed.jpg", "name": "GI Bleeding Management as per any GI bleed", "description": "Consult GI for upper endoscopy to determine site of bleeding from the gastrojejunostomy. Potential for surgery if site of bleeding not visualized, however most bleeding is self limited.", "width": "800" } 63 Case 3: 36 year old man presents with “crampy” intermittent epigastric pain, which radiates to his back No N/V, no diarrhea, no ‘sick contacts’, no questionable ingestions, no recent travel Past Medical History: healthy Past Surgical History: gastric bypass-1999 { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/63/Case+3%3A+36+year+old+man+presents+with+crampy+intermittent+epigastric+pain%2C+which+radiates+to+his+back..jpg", "name": "Case 3: 36 year old man presents with crampy intermittent epigastric pain, which radiates to his back.", "description": "No N/V, no diarrhea, no ‘sick contacts’, no questionable ingestions, no recent travel. Past Medical History: healthy. Past Surgical History: gastric bypass-1999.", "width": "800" } 64 Case 3: PE: decreased BS; no masses / organomegaly; mild epigastric tenderness on palpation; no rebound / guarding / peritoneal signs ECG = normal CXR = normal abdo (2 views)= normal { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/64/Case+3%3A+PE%3A+decreased+BS%3B+no+masses+%2F+organomegaly%3B+mild+epigastric+tenderness+on+palpation%3B+no+rebound+%2F+guarding+%2F+peritoneal+signs..jpg", "name": "Case 3: PE: decreased BS; no masses / organomegaly; mild epigastric tenderness on palpation; no rebound / guarding / peritoneal signs.", "description": "ECG = normal. CXR = normal. abdo (2 views)= normal.", "width": "800" } 65 Late Complications: Adhesive bowel obstructions Stricture/stenosisInternal hernias Reflux nutritional deficiencies (iron, vitamin B12, vitamin D, and calcium most commonly) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/65/Late+Complications%3A+Adhesive+bowel+obstructions+Stricture%2Fstenosis.jpg", "name": "Late Complications: Adhesive bowel obstructions Stricture/stenosis", "description": "Internal hernias. Reflux. nutritional deficiencies (iron, vitamin B12, vitamin D, and calcium most commonly)", "width": "800" } 66 Late Complications: Adhesive bowel obstructions Stricture/stenosisInternal hernias Reflux nutritional deficiencies (iron, vitamin B12, vitamin D, and calcium most commonly) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/66/Late+Complications%3A+Adhesive+bowel+obstructions+Stricture%2Fstenosis.jpg", "name": "Late Complications: Adhesive bowel obstructions Stricture/stenosis", "description": "Internal hernias. Reflux. nutritional deficiencies (iron, vitamin B12, vitamin D, and calcium most commonly)", "width": "800" } 67 Internal Hernias small-bowel herniation through 1)the mesenteric defect created at the distal anastomosis or 2) through a surgically created space between the transverse colon mesentery and the mesentery of the small bowel that comprises the Roux limb (herniation through this space is 3% to 5% (Comeau et al., 2005)) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/67/Internal+Hernias.jpg", "name": "Internal Hernias", "description": "small-bowel herniation through 1)the mesenteric defect created at the distal anastomosis or 2) through a surgically created space between the transverse colon mesentery and the mesentery of the small bowel that comprises the Roux limb (herniation through this space is 3% to 5% (Comeau et al., 2005))", "width": "800" } 68 Internal Hernias small-bowel herniation through 1)the mesenteric defect created at the distal anastomosis or 2) through a surgically created space between the transverse colon mesentery and the mesentery of the small bowel that comprises the Roux limb (herniation through this space is 3% to 5% (Comeau et al., 2005)) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/68/Internal+Hernias.jpg", "name": "Internal Hernias", "description": "small-bowel herniation through 1)the mesenteric defect created at the distal anastomosis or 2) through a surgically created space between the transverse colon mesentery and the mesentery of the small bowel that comprises the Roux limb (herniation through this space is 3% to 5% (Comeau et al., 2005))", "width": "800" } 69 Internal Hernias small-bowel herniation through 1)the mesenteric defect created at the distal anastomosis or 2) through a surgically created space between the transverse colon mesentery and the mesentery of the small bowel that comprises the Roux limb (herniation through this space is 3% to 5% (Comeau et al., 2005)) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/69/Internal+Hernias.jpg", "name": "Internal Hernias", "description": "small-bowel herniation through 1)the mesenteric defect created at the distal anastomosis or 2) through a surgically created space between the transverse colon mesentery and the mesentery of the small bowel that comprises the Roux limb (herniation through this space is 3% to 5% (Comeau et al., 2005))", "width": "800" } 70 Internal Hernias present with nonobstructive, intermittent, crampy, epigastric abdominal pain that often radiates to the back Unless the obstruction has led to ischemic compromise of the bowel, the abdominal examination is usually unrevealing If herniation involves afferent limb, then no air fluid levels on plain x-ray { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/70/Internal+Hernias+present+with+nonobstructive%2C+intermittent%2C+crampy%2C+epigastric+abdominal+pain+that+often+radiates+to+the+back..jpg", "name": "Internal Hernias present with nonobstructive, intermittent, crampy, epigastric abdominal pain that often radiates to the back.", "description": "Unless the obstruction has led to ischemic compromise of the bowel, the abdominal examination is usually unrevealing. If herniation involves afferent limb, then no air fluid levels on plain x-ray.", "width": "800" } 71 Internal Hernias Invesigation: CT or upper GI seriesFindings include areas of intussusception, transition points, or the classic ‘‘swirl sign’’ created by twisting of the bowel mesentery { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/71/Internal+Hernias+Invesigation%3A+CT+or+upper+GI+series.jpg", "name": "Internal Hernias Invesigation: CT or upper GI series", "description": "Findings include areas of intussusception, transition points, or the classic ‘‘swirl sign’’ created by twisting of the bowel mesentery.", "width": "800" } 72 Computed tomography patterns in small bowel obstruction after open distal gastric bypass. (Srikanth et al. Obes Surg Jun-Jul;14(6):811-22) retrospective chart review of 1,409 open distal Roux-en-Y gastric bypasses clinical and radiological findings in 29 patients with unusual forms of bowel obstruction (intussusception, internal hernias) identified on CT { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/72/Computed+tomography+patterns+in+small+bowel+obstruction+after+open+distal+gastric+bypass.+%28Srikanth+et+al.+Obes+Surg.+2004+Jun-Jul%3B14%286%29%3A811-22%29.jpg", "name": "Computed tomography patterns in small bowel obstruction after open distal gastric bypass. (Srikanth et al. Obes Surg. 2004 Jun-Jul;14(6):811-22)", "description": "retrospective chart review of 1,409 open distal Roux-en-Y gastric bypasses. clinical and radiological findings in 29 patients with unusual forms of bowel obstruction (intussusception, internal hernias) identified on CT.", "width": "800" } 73 Computed tomography patterns in small bowel obstruction after open distal gastric bypass. (Srikanth et al. Obes Surg Jun-Jul;14(6):811-22) RESULTS: 1 had peritonitis 1 had free air on plain film 9/14 patients (62%) had "non-specific" findings on x-rays (7 of these had an internal hernia, 2 with volvulus) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/73/Computed+tomography+patterns+in+small+bowel+obstruction+after+open+distal+gastric+bypass.+%28Srikanth+et+al.+Obes+Surg.+2004+Jun-Jul%3B14%286%29%3A811-22%29.jpg", "name": "Computed tomography patterns in small bowel obstruction after open distal gastric bypass. (Srikanth et al. Obes Surg. 2004 Jun-Jul;14(6):811-22)", "description": "RESULTS: 1 had peritonitis. 1 had free air on plain film. 9/14 patients (62%) had non-specific findings on x-rays (7 of these had an internal hernia, 2 with volvulus)", "width": "800" } 74 What about the white count?Srikanth et al, WBC count was normal in 20/27 patients (74%) including 5/6 (83%) with necrotic bowel { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/74/What+about+the+white+count.jpg", "name": "What about the white count", "description": "Srikanth et al, WBC count was normal in 20/27 patients (74%) including 5/6 (83%) with necrotic bowel.", "width": "800" } 75 How good is CT in picking up internal hernia after gastic bypass? { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/75/How+good+is+CT+in+picking+up+internal+hernia+after+gastic+bypass.jpg", "name": "How good is CT in picking up internal hernia after gastic bypass", "description": "How good is CT in picking up internal hernia after gastic bypass", "width": "800" } 76 A retrospective review of 1,000 Lap-RYGB identify postoperative internal hernias Results: 45 internal hernias were identified (4.5%) in 43 patients Hernia location included transverse colon mesentery (n=43, 95%) or Petersen’s defect (n=2, 5%) (the area between the mesentery of the Roux-limb and the transverse mesocolon) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/76/A+retrospective+review+of+1%2C000+Lap-RYGB.jpg", "name": "A retrospective review of 1,000 Lap-RYGB", "description": "identify postoperative internal hernias. Results: 45 internal hernias were identified (4.5%) in 43 patients. Hernia location included transverse colon mesentery (n=43, 95%) or Petersen’s defect (n=2, 5%) (the area between the mesentery of the Roux-limb and the transverse mesocolon)", "width": "800" } 77 Results: { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/77/Results%3A.jpg", "name": "Results:", "description": "Results:", "width": "800" } 78 Results: 86% of patients had a CT scan done before surgery, 10% had an upper GI, 7% had both studies done before surgery, and 14% did not have either When CT was used alone, 64% (22/34) were positive for an internal hernia Subsequent review of all imaging studies showed diagnostic abnormalities in 97%of the patients { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/78/Results%3A+86%25+of+patients+had+a+CT+scan+done+before+surgery%2C+10%25+had+an+upper+GI%2C+7%25+had+both+studies+done+before+surgery%2C+and+14%25+did+not+have+either..jpg", "name": "Results: 86% of patients had a CT scan done before surgery, 10% had an upper GI, 7% had both studies done before surgery, and 14% did not have either.", "description": "When CT was used alone, 64% (22/34) were positive for an internal hernia. Subsequent review of all imaging studies showed diagnostic abnormalities in 97%of the patients.", "width": "800" } 79 Any patient with unexplained abdominal pain, regardless of laboratory or radiologic findings, should be considered for surgical exploration { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/79/Any+patient+with+unexplained+abdominal+pain%2C+regardless+of+laboratory+or+radiologic+findings%2C+should+be+considered+for+surgical+exploration.jpg", "name": "Any patient with unexplained abdominal pain, regardless of laboratory or radiologic findings, should be considered for surgical exploration", "description": "Any patient with unexplained abdominal pain, regardless of laboratory or radiologic findings, should be considered for surgical exploration", "width": "800" } 80 Gastric Dilatation obstruction of the Roux limb that causes acute gastric dilatation (2o stenosis/stricture) Symptoms include abdominal pain, nausea, and vomiting if the distended stomach occludes the gastrointestinal tract by compression of the Roux limb diagnosis is confirmed by CT Management: percutaneous decompression in interventional radiology { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/80/Gastric+Dilatation+obstruction+of+the+Roux+limb+that+causes+acute+gastric+dilatation+%282o+stenosis%2Fstricture%29.jpg", "name": "Gastric Dilatation obstruction of the Roux limb that causes acute gastric dilatation (2o stenosis/stricture)", "description": "Symptoms include abdominal pain, nausea, and vomiting if the distended stomach occludes the gastrointestinal tract by compression of the Roux limb. diagnosis is confirmed by CT. Management: percutaneous decompression in interventional radiology.", "width": "800" } 81 Take Home Points: Laparoscopic Adjustable Gastric Banding (LAP-BAND):(1) Gastric prolapse through the band presents via food intolerance, vomiting, regurgitation, heartburn, and epigastric pain Deflate the adjustable band Gastrograffin swallow study Consult surgery and GI (re: URGENT gastroscopy) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/81/Take+Home+Points%3A+Laparoscopic+Adjustable+Gastric+Banding+%28LAP-BAND%29%3A.jpg", "name": "Take Home Points: Laparoscopic Adjustable Gastric Banding (LAP-BAND):", "description": "(1) Gastric prolapse through the band presents via food intolerance, vomiting, regurgitation, heartburn, and epigastric pain. Deflate the adjustable band. Gastrograffin swallow study. Consult surgery and GI (re: URGENT gastroscopy)", "width": "800" } 82 Take Home Points: Roux-en-Y Gastric Bypass:(1) anastomotic leaks MUST be considered in patients with tachycardia and fever in the first weeks after a Roux-en-Y Imaging of choice is CT with contrast (or upper GI series) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/82/Take+Home+Points%3A+Roux-en-Y+Gastric+Bypass%3A.jpg", "name": "Take Home Points: Roux-en-Y Gastric Bypass:", "description": "(1) anastomotic leaks MUST be considered in patients with tachycardia and fever in the first weeks after a Roux-en-Y. Imaging of choice is CT with contrast (or upper GI series)", "width": "800" } 83 Take Home Points: Roux-en-Y Gastric Bypass:(3) GI bleeding should be treated as per standard UGI bleed management Urgent GI consult for gastroscopy Bleeding is usually self-limited { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/83/Take+Home+Points%3A+Roux-en-Y+Gastric+Bypass%3A.jpg", "name": "Take Home Points: Roux-en-Y Gastric Bypass:", "description": "(3) GI bleeding should be treated as per standard UGI bleed management. Urgent GI consult for gastroscopy. Bleeding is usually self-limited.", "width": "800" } 84 Take Home Points: Roux-en-Y Gastric Bypass:(2) Internal hernias present with nonobstructive, intermittent, crampy, epigastric abdominal pain that often radiates to the back Clinical examination, laboratory and imaging investigations have poor sensitivity { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/84/Take+Home+Points%3A+Roux-en-Y+Gastric+Bypass%3A.jpg", "name": "Take Home Points: Roux-en-Y Gastric Bypass:", "description": "(2) Internal hernias present with nonobstructive, intermittent, crampy, epigastric abdominal pain that often radiates to the back. Clinical examination, laboratory and imaging investigations have poor sensitivity.", "width": "800" } 85 Take Home Points: Roux-en-Y Gastric Bypass:(4) Gastric dilatation presents with obstructive symptoms CT to confirm diagnosis percutaneous decompression via interventional radiology { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/85/Take+Home+Points%3A+Roux-en-Y+Gastric+Bypass%3A.jpg", "name": "Take Home Points: Roux-en-Y Gastric Bypass:", "description": "(4) Gastric dilatation presents with obstructive symptoms. CT to confirm diagnosis. percutaneous decompression via interventional radiology.", "width": "800" } 86 References Balsiger BM, Poggio JL, Mai J, et al. Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity. J Gastrointest Surg. 2000;4: Biertho L, Steffen R, Ricklin T, et al. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: a comparative study of 1,200 cases. J Am Coll Surg. 2003;197: Comeau E, Gagner M, Inabnet WB, et al. Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc. 2005; 19:34-39. Eric D. Edwards, MD Brian P. Jacob, MD, et al. Presentation and Management of Common Post–Weight Loss Surgery Problems in the Emergency Department. Ann Emerg Med. 2006;47: Garza, Jr., et al. Internal hernias after laparoscopic Roux-en-Y gastric bypass. The American Journal of Surgery 188 (2004) 796–800 Landen MD,, Bernard M, et al. Complications of gastric banding presenting to the ED. American Journal of Emergency Medicine (2005) 23, 368–370 Lujan JA, Frutos MD, Hernandez Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg. 2004;239: { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4734772/15/images/86/References.jpg", "name": "References", "description": "Balsiger BM, Poggio JL, Mai J, et al. Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity. J Gastrointest Surg. 2000;4:598-605. Biertho L, Steffen R, Ricklin T, et al. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: a comparative study of 1,200 cases. J Am Coll Surg. 2003;197:536-544. Comeau E, Gagner M, Inabnet WB, et al. Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc. 2005; 19:34-39. Eric D. Edwards, MD Brian P. Jacob, MD, et al. Presentation and Management of Common Post–Weight Loss Surgery Problems in the Emergency Department. Ann Emerg Med. 2006;47:160-166. Garza, Jr., et al. Internal hernias after laparoscopic Roux-en-Y gastric bypass. The American Journal of Surgery 188 (2004) 796–800. 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Obes Surg 2004;14:142- 4.", "width": "800" } Ppt on centring point Ppt on marie curie fellowship Ppt on question tags songs Ppt on data collection methods for research Ppt on sea level rise data Ppt on personality development in hindi Ppt on articles Ppt on elections in india download movies Ppt on job rotation letter Ppt on scanner and its types Weight Loss Surgery: The First Step Toward a More Healthy Life.Post-Surgical Care of the Bariatric PatientBariatric Surgery Mr B.M.Axisa Consultant Laparoscopic and Upper GI Surgeon.Carle Bariatrics Weight Loss Surgery Seminar. Major public health problem worldwide Affects 30% of industrialized world American statistics: – 60% of.BY: HILLARY SULLIVAN MEDICAL NUTRITION THERAPY BASIC EXPLANATION OF BARIATRIC SURGERY TYPES.Vomiting, Diarrhea & Constipation© 2003 By Default! A Free sample background from Slide 1 Complications of Bariatric Surgery Presented by: Robyn Ache, D.O. Fellowship.Fight obesity with effective and guaranteed tools t Haitham Al-Khayat, MD Consultant general and bariatric surgeon New Dar Al-Shifa hospital.Section 1 Review. Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Nonalcoholic fatty liver disease steatosissteatohepatitiscirrhosis.Complications Associated with Laparoscopic Adjustable Gastric Banding for Morbid Obesity Dr. Mojtaba Hashemzadeh Dr. Leila Zahedi-Shoolami Dr. Mahmoud.Gastrointestinal Surgery for Severe Obesity Prepared By: Dr. Fahad Al-Jindan Dr. Fahad Al-Jindan.Review on enterocutaneous fistulaהשמנת יתר חמד " ע פרופ ' ארדון רובינשטין.Dr.Mohammad foudazi Research center of endoscopic surgery, Iran medical university.Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey.What is a Lap-Band? A restrictive gastric banding procedure was first introduced in 1983 made adjustable in 1986 made available laparoscopically in the.Gastric Obstruction post “Sleeve gastrectomy”IMAGE CHALLENGE. A 51-year-old woman with a history of hypertension and chronic constipation presented with abdominal pain of 2 weeks' duration. The.Gastric Surgery for Severe Obesity David L. Gee, PhD Professor of Food Science and Nutrition Central Washington University.Morbid Obesity Surgery CDR Craig Shepps MD, FACS. Similar presentations © 2017 SlidePlayer.com Inc. All rights reserved.





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