Summary of descriptive statistics of variables.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"5352",leadTitle:null,fullTitle:"Synopsis in the Management of Urinary Incontinence",title:"Synopsis in the Management of Urinary Incontinence",subtitle:null,reviewType:"peer-reviewed",abstract:"The prevalence of urinary incontinence increases with age. It has recognised social and psychological impact on individuals as well as a financial implication to individuals and healthcare systems. The book attempt to discuss the assessment of urinary incontinence, followed by surgical and conservative treatment options in a concise way, within the framework of clinical practice. We would like to acknowledge all the authors for their hard work in completing this book.",isbn:"978-953-51-2932-5",printIsbn:"978-953-51-2931-8",pdfIsbn:"978-953-51-7337-3",doi:"10.5772/62557",price:119,priceEur:129,priceUsd:155,slug:"synopsis-in-the-management-of-urinary-incontinence",numberOfPages:110,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"7793498d8fd7ab427e9449e34faf438c",bookSignature:"Ammar Alhasso and Holly Bekarma",publishedDate:"February 8th 2017",coverURL:"https://cdn.intechopen.com/books/images_new/5352.jpg",numberOfDownloads:8912,numberOfWosCitations:4,numberOfCrossrefCitations:11,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:12,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:27,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 23rd 2016",dateEndSecondStepPublish:"March 15th 2016",dateEndThirdStepPublish:"June 19th 2016",dateEndFourthStepPublish:"September 17th 2016",dateEndFifthStepPublish:"October 17th 2016",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"124685",title:"Mr.",name:"Ammar",middleName:null,surname:"Alhasso",slug:"ammar-alhasso",fullName:"Ammar Alhasso",profilePictureURL:"https://mts.intechopen.com/storage/users/124685/images/2428_n.jpg",biography:"Ammar Alhasso is a consultant urological surgeon and lead in reconstructive urology, female urology and urodynamics at the University of Edinburgh Teaching Hospitals. He was a research fellow at Imperial College School of Medicine, University of London studying bladder cancer and obtained a Master degree in Surgical Sciences in 2000. He is also a reviewer for the Cochrane Collaboration/Incontinence Group and has published systematic reviews and meta-analyses on urinary incontinence in men and women. With commitment to training and education, Ammar has the Assigned Educational Supervisory role within the East of Scotland Training Programme in Urology, he is also the Associate Editor for BJUI Knowledge on Reconstructive Urology, Female Urology and Urodynamics. He is also the module lead for reconstructive urology on the ChM in Urology course at the Royal College of Surgeons of Edinburgh and the University of Edinburgh.",institutionString:null,position:"Consultant Urological Surgeon",outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"2",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"196492",title:"Dr.",name:"Holly",middleName:null,surname:"Bekarma",slug:"holly-bekarma",fullName:"Holly Bekarma",profilePictureURL:"https://mts.intechopen.com/storage/users/196492/images/5118_n.png",biography:"Holly Bekarma FRCS Urol graduated from the University of Manchester and is a final year Urology Registrar in the West of Scotland. She has developed a sub-specialist interest in female urology and the management of incontinence. Ms Bekarma has authored several peer reviewed publications, book chapters and presented widely on a national and international level on the topics of urinary incontinence, vaginal mesh complications and oncology. Ms Bekarma is actively involved in medical education and is presently undertaking a Master’s degree from the University of Glasgow, investigating the impact of gender on self-assessment within urology trainees.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1162",title:"Endourology",slug:"endourology"}],chapters:[{id:"53692",title:"Assessment of Urinary Incontinence (UI) in Adult Patients",doi:"10.5772/66953",slug:"assessment-of-urinary-incontinence-ui-in-adult-patients",totalDownloads:2043,totalCrossrefCites:3,totalDimensionsCites:4,hasAltmetrics:0,abstract:"The diagnosis and assessment of urinary incontinence (UI) are variable. In general, diagnosis is made in primary care using clinical evaluation (a good history and physical examination), bladder diary and validated symptom scales. Condition-specific diagnosis is made in secondary care, and it often involves interventional tools such as urodynamic studies. The evidence available on the accuracy and acceptability of the assessment of UI is inconsistent and variable. A structured data collection tool was used for initial assessment of UI. Some key questions are required for initial assessment of UI in order to diagnose the type of UI. This chapter includes a gender-specific evaluation based on history and clinical examination. Pelvic organ prolapse (POP) in female patients is associated with UI and POP diagnosis, and staging is made by clinical examination only, while male patients are examined for prostate obstructive urinary symptoms. Basic evaluation includes bladder diary in cases of overactive bladder and stress test, for stress urinary incontinence. Other diagnostic tests include urine analysis, uroflowmetry and measurement of post-void residual volume in cases of neurogenic bladder and benign prostate hypertrophy. Patients referred to specialist require further assessment of UI using urodynamic testing, electrophysiological test and imaging.",signatures:"Raheela M. Rizvi and Mohammad Hammad Ather",downloadPdfUrl:"/chapter/pdf-download/53692",previewPdfUrl:"/chapter/pdf-preview/53692",authors:[{id:"88868",title:"Prof.",name:"M Hammad",surname:"Ather",slug:"m-hammad-ather",fullName:"M Hammad Ather"},{id:"185970",title:"Dr.",name:"Raheela",surname:"Rizvi",slug:"raheela-rizvi",fullName:"Raheela Rizvi"}],corrections:null},{id:"53709",title:"Adjustable Midurethral Slings in the Treatment of Female Stress Urinary Incontinence",doi:"10.5772/66856",slug:"adjustable-midurethral-slings-in-the-treatment-of-female-stress-urinary-incontinence",totalDownloads:1421,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Midurethral slings have become the gold standard in the surgical treatment of stress urinary incontinence (SUI). However, despite the high cure rates with these procedures, nearly 20% of the patients are incontinent after surgery. On the other hand, in a small percentage of women, voiding dysfunction may develop after surgery. Adjustable slings have been advocated in patients who fail an anti-incontinence surgery or have intrinsic sphincter deficiency (ISD) or in order to prevent postoperative voiding dysfunction. There are various options of adjustable slings according to the surgical route or the type of mesh used.",signatures:"Funda Gungor Ugurlucan and Cenk Yasa",downloadPdfUrl:"/chapter/pdf-download/53709",previewPdfUrl:"/chapter/pdf-preview/53709",authors:[{id:"83201",title:"Dr.",name:"Funda",surname:"Gungor Ugurlucan",slug:"funda-gungor-ugurlucan",fullName:"Funda Gungor Ugurlucan"}],corrections:null},{id:"53511",title:"Complementary and Alternative Medicine Treatment for Urinary Incontinence",doi:"10.5772/66705",slug:"complementary-and-alternative-medicine-treatment-for-urinary-incontinence",totalDownloads:1608,totalCrossrefCites:4,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Complementary and alternative medicine has been widely used for various diseases and gained acceptance throughout the industrialized world. Basically, complementary and alternative medicine is grouped into five domains: biologically based therapies, mind-body interventions, manipulative and body-based approaches, energy therapies and whole medical systems. Each domain covers a number of therapies. In this chapter, we present the evidence about effectiveness of each complementary and alternative medicine therapy as well as the possible mechanism on the treatment of urinary incontinence. Besides reviewing existed evidence, our research and clinical experience are also presented.",signatures:"Ran Pang, Ri Chang, Xin-Yao Zhou and Chun-Lan Jin",downloadPdfUrl:"/chapter/pdf-download/53511",previewPdfUrl:"/chapter/pdf-preview/53511",authors:[{id:"186524",title:"Prof.",name:"Ran",surname:"Pang",slug:"ran-pang",fullName:"Ran Pang"},{id:"193855",title:"Dr.",name:"Xin-Yao",surname:"Zhou",slug:"xin-yao-zhou",fullName:"Xin-Yao Zhou"},{id:"200293",title:"Dr.",name:"Ri",surname:"Chang",slug:"ri-chang",fullName:"Ri Chang"},{id:"200300",title:"Prof.",name:"Chun-Lan",surname:"Jin",slug:"chun-lan-jin",fullName:"Chun-Lan Jin"}],corrections:null},{id:"53697",title:"Physiotherapy in Women with Urinary Incontinence",doi:"10.5772/66704",slug:"physiotherapy-in-women-with-urinary-incontinence",totalDownloads:2413,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Urinary incontinence is a complex and serious condition that can affect all age groups around the world. It is not only a serious medical condition but also an undeniable psychosocial problem creating embarrassment and negative self‐perception, and it has a severe impact on a patient's quality of life. Today, there are wide different treatment options in urinary incontinence from surgery to conservative modalities. Among these, conservative management approaches are recommended as the first‐line treatment to manage with urinary incontinence. The choice of the most suitable option to treat for urinary incontinence differs according to the underlying pathophysiological mechanism defining subtypes of urinary incontinence and severity of symptoms. In this chapter, we addressed the different components of physiotherapy management of urinary incontinence, including pelvic floor muscle training, electrical stimulation, biofeedback, vaginal cones, mechanical devices and magnetic stimulation. We concluded that the optimal physiotherapy care should be individualised to ensure applicability the clinic setting for each patient.",signatures:"Özlem Çinar Özdemir and Mahmut Surmeli",downloadPdfUrl:"/chapter/pdf-download/53697",previewPdfUrl:"/chapter/pdf-preview/53697",authors:[{id:"185712",title:"Ph.D.",name:"Özlem",surname:"Çinar Özdemir",slug:"ozlem-cinar-ozdemir",fullName:"Özlem Çinar Özdemir"},{id:"193852",title:"Mr.",name:"Mahmut",surname:"Surmeli",slug:"mahmut-surmeli",fullName:"Mahmut Surmeli"}],corrections:null},{id:"53493",title:"Medical and Surgical Treatment for Overactive Bladder",doi:"10.5772/66709",slug:"medical-and-surgical-treatment-for-overactive-bladder",totalDownloads:1428,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In this chapter, we focus on the medical treatment of overactive bladder (OAB) syndrome. The treatment of choice of the OAB syndrome is still the anticholinergic therapy, although we must consider β3‐agonists with almost the same evidence. No drug has been shown to be clearly superior to the rest. The use of oxybutynin transdermal should be considered when the side effects due to the oral administration are intolerable. In elderly patients, first efforts should be directed to use non‐drug therapies, such as behavioural therapy. In patients suffering from cognitive dysfunctions, the use of antimuscarinic with caution is recommended. Mirabegron, a β3‐agonist, can be offered, although it should be noted that the long‐term effects are still unknown. The logical second‐line treatment is the intravesical injection of botulinum toxin A, considering its temporary effectiveness and the possibility of retention. In some centres, sacral nerve stimulation may be an option. Surgical treatment should be reserved when conservative therapies fail.",signatures:"Rodrigo Garcia-Baquero, Madurga Patuel Blanca, Lafuente\nMolinero Candelaria and Alvarez-Ossorio Jose Luis",downloadPdfUrl:"/chapter/pdf-download/53493",previewPdfUrl:"/chapter/pdf-preview/53493",authors:[{id:"185782",title:"Dr.",name:"Rodrigo",surname:"Garcia-Baquero",slug:"rodrigo-garcia-baquero",fullName:"Rodrigo Garcia-Baquero"},{id:"193860",title:"Dr.",name:"Blanca",surname:"Madurga Patuel",slug:"blanca-madurga-patuel",fullName:"Blanca Madurga Patuel"},{id:"193862",title:"Dr.",name:"Candelaria",surname:"Lafuente Molinero",slug:"candelaria-lafuente-molinero",fullName:"Candelaria Lafuente Molinero"},{id:"194046",title:"Dr.",name:"Jose Luis",surname:"Alvarez-Ossorio",slug:"jose-luis-alvarez-ossorio",fullName:"Jose Luis Alvarez-Ossorio"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"1448",title:"Urinary Incontinence",subtitle:null,isOpenForSubmission:!1,hash:"0c33f52801c170a775dceb2163295aa3",slug:"urinary-incontinence",bookSignature:"Ammar Alhasso",coverURL:"https://cdn.intechopen.com/books/images_new/1448.jpg",editedByType:"Edited by",editors:[{id:"124685",title:"Mr.",name:"Ammar",surname:"Alhasso",slug:"ammar-alhasso",fullName:"Ammar Alhasso"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1318",title:"Urinary Tract Infections",subtitle:null,isOpenForSubmission:!1,hash:"018471a7330e239e2bfbd8b11b1111ca",slug:"urinary-tract-infections",bookSignature:"Peter Tenke",coverURL:"https://cdn.intechopen.com/books/images_new/1318.jpg",editedByType:"Edited by",editors:[{id:"62770",title:"Dr.",name:"Peter",surname:"Tenke",slug:"peter-tenke",fullName:"Peter Tenke"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3313",title:"Recent Advances in the Field of Urinary Tract Infections",subtitle:null,isOpenForSubmission:!1,hash:"02d234a9ee56794bfa06cce7bb94fdf1",slug:"recent-advances-in-the-field-of-urinary-tract-infections",bookSignature:"Thomas Nelius",coverURL:"https://cdn.intechopen.com/books/images_new/3313.jpg",editedByType:"Edited by",editors:[{id:"53464",title:"Prof.",name:"Thomas",surname:"Nelius",slug:"thomas-nelius",fullName:"Thomas Nelius"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6147",title:"Urinary Tract Infection",subtitle:"The Result of the Strength of the Pathogen, or the Weakness of the Host",isOpenForSubmission:!1,hash:"16821e1bfd105986c31e991510e94e70",slug:"urinary-tract-infection-the-result-of-the-strength-of-the-pathogen-or-the-weakness-of-the-host",bookSignature:"Tomas Jarzembowski, Agnieszka Daca and Maria Alicja Dębska-Ślizień",coverURL:"https://cdn.intechopen.com/books/images_new/6147.jpg",editedByType:"Edited by",editors:[{id:"205604",title:"Dr.",name:"Tomas",surname:"Jarzembowski",slug:"tomas-jarzembowski",fullName:"Tomas Jarzembowski"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1762",title:"Evolving Trends in Urology",subtitle:null,isOpenForSubmission:!1,hash:"4b9965c1c8ed456914c0a375d06d1df8",slug:"evolving-trends-in-urology",bookSignature:"Sashi S. 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It is a commodity that is vital for the existence of modern household living [1, 2]. In fact, the total welfare of a household depends on the type and the pattern of the household’s energy utilisation. The household energy consumption pattern in Bauchi state can be categorised into three major dimensions: cooking, lighting and cooling purposes. For satisfying the needs of cooking, various sources are available, which includes: fuel-wood, kerosene, gas and electricity, plus elements of plant residues and animal dung which are used in some parts of the rural areas of the state. For lighting purpose, the various choices mainly include: electricity, petroleum/diesel (used for fuelling generators), kerosene, candles, traditional lamps and firewood, mostly based on socio-economic status of a household [3, 4]. Furthermore, for the purpose of drinks and space cooling, various energy sources are available which consist of mainly electricity and petroleum or diesel (gas) power generator.
Of all the above categories of fuel sources, electricity, liquefied petroleum gas (LPG) and kerosene are regarded to be either cleaned (i.e. in the case of electricity and gas) or transitional (i.e. in the case of kerosene) energy sources [5], while the traditional biomass fuel that include fuel-wood, animal dung and plant residues are not cleaned energy which can lead to numerous economic, social, health and environmental problems [6, 7].
The use of traditional lamp as the main source of lighting is a threat to the health and the life of the users; this is because such traditional lamp produces high rate of carbon monoxide that is harmful to human health; that is why in most of the rooms whereby such lamps are being used, there exist black dust in ceilings and the walls closer to the lamp. In the same vein, the use of fuel-wood for cooking and lighting purposes is totally not environmental friendly. It has negative impacts on the atmosphere and peoples’ lives [8, 9]. Apart from deforestation, desertification and soil erosion, the use of fuel-wood has a very low thermal efficiency and the smoke is also hazardous to human health, especially to women and children who mostly do the cooking in homes [10]. Acute respiratory infections (ARI) in children are one of the leading causes of infant and child morbidity and mortality [11, 12]. Studies have found associations between biomass fuel use and lung cancer. A 30-year-old woman cooking with straw or wood has an 80% increased chance of having lung cancer later in life [13, 14].
The underlying rational here is to encourage households to shift from the use of non-cleaned energy sources to the adoption of cleaned energy sources [15]. This is because there are so many benefits in using a cleaned energy. It has been widely argued that moving towards the use of cleaned fuels is an important option to improve the standard of living for households who rely heavily on biomass [16]. It is the key factor to improve the mode of living for rural population [17]. Moreover, encouraging households to switch to cleaned energy would lead to the consumption of less fuel per meal and less time spent for gathering fuel which could be used in other activities such as attending school and other income generating activities [5]. Cleaned energy provides easy access to education, health care and household resources. Children who do not have to collect bio fuels can attend school [18, 19]. Switching to cleaned fuels could also free up time for women to engage in income-generating pursuits [18].
To attain these benefits, a very important and effective policy that provides access to cleaned energy is required [9]. However, such effective policy also depends on a good research which is conducted to investigate and explore households’ energy consumption pattern in relevant area [20]. This study is conducted with the major aim of exploring socio-demographic features of households and their pattern of energy choice and consumption in Bauchi state, Nigeria, to assess the correlation between the energy consumption and the socio-demographic characteristics of households in Bauchi state.
The remaining part of the chapter is as follows: Section 2 consists of the review of related literature, Section 3 consists of methodology and Section 4 discussed the results and findings of the study. The last section consists of conclusions and policy implications of the study.
This section examines and highlights the factors that influence the level of household fuel choice and consumption. Each of these factors is expected to relate with the quantity of fuel consumption of households either positively or negatively. The explanation of different categories of factors influencing the households’ energy choice and consumption is explained below.
These are the factors that serve as a measure of economic status of the household which can influence the households’ fuel consumption decision. For instance, studies have established that there is a positive relationship between the households’ income and the adoption of cleaned energy [21, 22, 23]. Poorer households especially in developing countries tend to adopt firewood, plant residues, animal dung and other un-cleaned energy sources, whereas wealthier households tend to adopt energy from more cleaned sources.
A relationship also exists between the type of occupation of the household head and the nature of the energy source to be adopted by the household. Empirical studies conducted in [2, 24] proved that those in white-collar jobs (executives, big entrepreneurs) adopt cleaned energy, while those in blue-collar jobs (such as farming, trading) tend to adopt firewood and other biomass fuels. Home ownership, which is one of the indicators of the economic status of households, affects their decision on the type of energy sources to adopt. Those who live in their owned house tend to adopt cleaned energy source [22, 25]. Price of energy has a negative relationship with energy consumption. When the price of a particular energy source is high, households switch to other alternative fuel available. This is in line with the law of demand and also has been established by previous studies [9, 26].
The type and composition of socio-demographic factors of households influence their fuel switching and consumption behaviour. For instance [27], we found that households tend to adopt cleaner energy when the head of the household is female. The age of the household head was found to have a negative relationship with the adoption of cleaned energy [27, 28]. Households adopt less cleaned energy source when the head is older. The level of education of the household head has a positive relationship with cleaned energy adoption. When the higher educated is the household head, the more he realises the negative impact of un-cleaned energy, and therefore, the less it will be adopted [2, 25]. The location of household was also established to affect the nature of energy use. Households that live in the urban areas tend to spent more on electricity than those living in the rural areas [29]. The number of a household’s members (i.e. household size) affects the household’s energy consumption decision; the larger the size of a household, the lesser the adoption of cleaned energy [30, 21]. Lastly in [31], it is established that there is a strong relationship between the household energy use and the level of education of the household head.
The characteristics of the building in which the households leave can also affect their energy choice behaviour. For instance, the location of the home in which the households live have serious impact on their energy consumption decision. The households that are located in urban areas adopt cleaner energy than their rural counterparts [2, 21]. In addition, the type of the house (i.e. nature of the building) exacts some influence on household energy consumption behaviour. For instance, in [2, 21], it was empirically found that living in detached house has significant positive relationship with the adoption of gas, electricity and liquid fuel. The sizes of the residence in which households live also influence their energy consumption behaviour. Most of the previous studies, such as [22, 32, 33], found that the larger the size of the building, the higher the adoption of fuel wood, all things being equal. Furthermore, the number of rooms in the house is one of the building characteristics which influence households’ energy consumption choice. For instance, in [2, 24], it was found that this variable has a positive significant relationship with the household use of liquefied petroleum gas (LPG). Share of dwellings (i.e. more than one household living in the same building) is one of the factors which also shapes the energy consumption behaviour of households [22].
Because this chapter is a study of households at micro level, this section contains the description of the study samples and the methods used in data gathering.
In this study, the total sample size was determined based on [34]. The formula for determining a good representative sample is:
where
Therefore, the sample size can be determined as:
This formula has been widely applied in household micro level studies [35, 36, 37, 38]. Furthermore, it commensurates with the sample size recommended by social science researchers. For instance, in [39], a rule of thumb is given for selecting a good sample size which is larger than 30 and less than 500 for most of the research; and that in case of multivariate studies, the sample size should be at least 10 times as large as the number of variables. In [40], a rule of thumb for the accurate sample size of at least 5–10 times larger than the number of variables is given. However, for the purpose of data collection for this study, a total of 750 questionnaires were distributed instead of the pre-determined sample number of 384 samples. This was to avoid a problem of non-response rate. According to [41], since it is not every selected sample that will likely response, there is a need for a researcher to increase the sample size to avoid non-response bias. Babbie (1995) (cited in [42]) argued that at least 50% rate of response is necessary for reporting and analysis. Finally, about 548 filled questionnaires were returned back, which is more than 70% of the total number of the issued questionnaires.
For the purpose of this study, cluster area sampling method was adopted. According to [43], area sampling is a special type of cluster sampling whereby samples are grouped and clustered on the basis of geographical location areas [44, 45]. The reason for adopting this method of sampling is that though the sampling frame for the various clusters of Bauchi state is available and was obtained from the office of Nigerian National Population Commission, there is no available frame containing the list of all households living in Bauchi state. Hence in this situation, area sampling is one of the most suitable techniques of data collection. As argued by various scholars, the underlying practical motivation for using area sampling is the absence of complete and accurate list of the universal elements under study since it does not depend upon the population frame [44, 45, 46]. Moreover, from [47], it was argued that in the case of cluster sampling, the full list of clusters forms the sampling frame and not the list of individual elements within the population.
The sampling technique used in this study is the multistage cluster sampling. In the first stage, the whole of the study area was divided into three groups (clusters) based on the geo-political zonal categorisation of the study area; the various categories are: Bauchi South, Bauchi Central and Bauchi North. In the second stage, two clusters (Bauchi South and Bauchi North) were selected randomly out of the three clusters.
In the third stage, these two clusters were further categorised into two sub-clusters: urban and rural areas. Then, a total of 10 wards were randomly selected from the urban areas, while a total of 13 wards were selected randomly from the rural areas. This gives a total of 23 selected wards used as the sampling wards. In the fourth stage, six communities were selected randomly from each of the selected wards of urban areas, which made a total of 60 communities from the urban areas. On the other hand, another six communities were randomly selected from the selected wards of the rural areas making a total of 78 communities used from the rural areas. This gives a total of 100 and 138 sampled communities used in the study. In the last stage, six households were systematically selected from each of the selected communities of the urban areas making a total of 360 (i.e. 60 × 6 = 360) households selected from the urban areas. On the other hand, five households were selected systematically from each of the selected communities of the rural areas making a total of 390 (i.e. 78 × 5 = 390) households selected from the rural areas. Finally, a total of 548 households returned the filled questionnaires out of which nine questionnaires were discarded.
This section contains the findings of this study. Since this study is a descriptive and exploratory analysis, the tools that were used to analyse the data are the various descriptive statistics, frequencies, percentages and correlation analyses.
This section provides information about the descriptive statistics. The major descriptive statistics are the mean, standard deviation, minimum and maximum. Table 1 exhibits the values of the summary statistics.
Variables | Mean | SD | Min | Max | |
---|---|---|---|---|---|
Gender | 538 | 0.874 | 0.33 | 0 | 1 |
Age | 536 | 36.43 | 11.7 | 23 | 60 |
Marital status | 528 | 0.739 | 0.44 | 0 | 1 |
Household size | 536 | 7.725 | 6.04 | 2 | 30 |
Location | 537 | 0.538 | 0.50 | 0 | 1 |
Home size (ft2) | 536 | 52.42 | 19.3 | 20 | 110 |
Number of rooms | 536 | 6.515 | 3.81 | 2 | 23 |
Cooking fuel main source | 539 | 0.443 | 0.81 | 0 | 3 |
Hours of electricity | 519 | 27.30 | 27.8 | 0 | 97 |
Price of firewood | 483 | 76.67 | 35.3 | 30 | 220 |
Price of kerosene | 361 | 126.6 | 27.1 | 45 | 200 |
Home appliances | 535 | 15.37 | 13.1 | 0 | 57 |
Home ownership | 535 | 0.213 | 0.41 | 0 | 1 |
Years of education | 536 | 14.21 | 6.17 | 0 | 22 |
Lighting fuel main source | 532 | 0.438 | 0.67 | 0 | 2 |
Firewood quantity | 449 | 34.23 | 17.1 | 4 | 90 |
Income (USD) | 536 | 224.0 | 180 | 78 | 600 |
Summary of descriptive statistics of variables.
Source: authors, 2019.
Table 1 shows that the monthly average consumption of firewood is about 35 bundles; this implies that on average, every household in Bauchi State uses more than one bundle of firewood everyday, which is a clear reflection of the high rate of firewood use in the state. Furthermore, the table indicates that the monthly average income of a household is little bit more than USD 200, with the maximum value of USD 600. This implies that most of the household in Bauchi State belong to the poor income group. In fact, Bauchi State is the third poorest state in Nigeria [48]. Furthermore, the table indicates that the average firewood price per bundle is about ₦75 (about $0.40). Furthermore, it indicates that on average, the household size in Bauchi state constitutes about eight members per household. This number approximately is tally to the estimated average household size in Bauchi state, given in [49]. The table shows that the average weekly hours of electricity supply is only 27 hours; this clearly reflects the nature of inadequate supply of electricity in the area, which is one of the factors that likely contributes to the high rate of biomass fuel use as the main source of energy by households in Bauchi state. Table 1 further shows that the average years of school experience by the heads of households in the study area is 14 years, representing a schooling experience up to the Diploma/NCE levels of education. Similarly, the reported average number of rooms in the building in which each household lives is six. This number constitutes bedrooms, rest room, sitting rooms and fallows. Additionally, the number of energy use devices possesses at home such as: bulbs, fans, ACs, televisions and radios among others shows an average value of 15 pieces of these items, which is clearly a reflection of low rate of modern energy use by households in the study area. Lastly, the table shows that the average age of household head in Bauchi state measured in terms of years is 36 years, which falls within the age group of working population.
The objective of this study is to explore and describe the socio-economic characteristics of households in Bauchi state, Nigeria, and their pattern of energy consumption. In this section, the study explored the socio-economic characteristics of households in Bauchi state and their pattern of fuel consumption, based on the study samples. Table 2 indicates the socio-demographic and economic characteristics of the respondents.
Characteristics | Frequency | (%) | CUM |
---|---|---|---|
Male | 470 | 87.36 | 87.36 |
Female | 68 | 12.64 | 100 |
16–30 | 187 | 34.89 | 34.89 |
31–45 | 229 | 42.72 | 77.61 |
46–60 | 97 | 18.10 | 95.71 |
Above 60 | 23 | 4.29 | 100 |
Single | 138 | 26.14 | 26.14 |
Married | 390 | 73.86 | 100 |
Non-formal education | 55 | 10.26 | 10.26 |
Primary School | 27 | 5.04 | 15.30 |
Secondary | 95 | 17.72 | 33.02 |
Diploma/NCE | 191 | 35.63 | 68.66 |
B.Sc./HND | 124 | 23.13 | 91.79 |
Postgraduate | 44 | 8.21 | 100 |
No standard job | 59 | 11.09 | 11.09 |
Farmer | 68 | 12.78 | 23.87 |
Teacher | 106 | 19.92 | 43.80 |
Banker | 17 | 3.20 | 46.99 |
Lecturer | 18 | 3.38 | 50.38 |
Medical practitioner | 37 | 6.95 | 57.33 |
Businessman | 99 | 18.61 | 75.94 |
Others | 128 | 24.06 | 100 |
150 and below | 277 | 53.37 | 53.37 |
151–$300 | 98 | 18.11 | 71.48 |
301–$450 | 73 | 13.10 | 84.59 |
451–$600 | 56 | 10.02 | 94.61 |
Above 600 | 32 | 5.39 | 100 |
1–10 | 424 | 79.22 | 79.22 |
11–20 | 94 | 17.44 | 96.66 |
21 and above | 18 | 3.34 | 100 |
Socio-economic characteristics of households in Bauchi state.
Source: Authors, 2019.
Table 2 shows that a majority of the respondents (87%) are males. This is because based on the culture of people in the study area, normally males occupy the position of household head; even in a situation when the father (the head) has died, it is the younger brother of the deceased or the first born in the family, not the mother, who emerges as a new head of the family. Because the belief is that, men are stronger than women economically, socially and educationally. Therefore, a woman emerges as a household head only by chance when there is no able man in the family to look after the affairs of the family. Furthermore, Table 2 shows that most of the respondents (61%) are within the age of middle adulthood stage (31–60 years). This is because on average, the normal marriage age for males (who are mostly the family head) begins from 25 years and above. The table further indicates that about 75% of the respondents are married, due to the fact that married people are regarded as responsible for overseeing the family affairs. The remaining 25% are regarded as single person comprising the divorced, widowed and separated. Regarding the family size, most of the respondents (80%) argued that the size of their family members is within the range of 1–10, the range in which the number of the average family size in Bauchi state reported earlier in [49] falls (i.e. 8) and this study found the average size of a household to be 8 (see Table 1). In addition, the categories of the education level attainment shows that those who attended school up to the Diploma/NCE level have the highest rate (35%) followed by those with the degree certificate (23%). Those who claimed that they did not attend a formal school at all constitute about 10% of the respondents. Only 8% of the respondents claimed to have attended school at a postgraduate level. Regarding the occupation of the respondents, of all those that have chosen a stated category, teaching job (at primary or secondary levels) obtained the highest proportion (about 20%). This is because teaching job at either primary or secondary school levels is one of the easy to find jobs for both semi-professional (Diploma/NCE) and professional (Degree and above) workers. About 11% of the respondents argued that they do not have a standard job; they are more of casual workers. Additionally, the 24% of the respondents, which constitutes the other occupation category as specified by the respondents themselves, comprises: tailoring, butcher, mechanic, welding, building construction, civil servant, businessman, journalist, sheep and cattle rearing. Others are: carpenter, porter, sewing, blacksmith, commercial driver, prison service and wood cutter. At Last, on average, most of the respondents (53%) argued that they usually earned a monthly income that is below $150. This clearly indicates the high rate of poverty in the state especially in the rural areas of the state.
Furthermore, among the factors that can shape the household pattern of energy consumption and switching are the characteristics of the building in which the household live. Table 3 contains the information of the home characteristics of the households.
Characteristics | Frequency | (%) | CUM |
---|---|---|---|
Self-owned home Non self-owned home | 421 114 | 78.69 21.31 | 78.69 100 |
1–5 6–10 11–15 16 and above | 305 112 106 13 | 56.90 20.90 19.54 2.43 | 56.90 77.80 97.34 100 |
1–24 25–49 50–74 75–99 100 and above | 35 138 300 27 36 | 6.53 25.75 55.97 5.04 6.72 | 6.53 32.28 88.25 93.29 100 |
Urban area Rural area | 289 248 | 53.82 46.18 | 46.18 100 |
Households’ home characteristics in Bauchi state.
Source: Authors, 2019.
Table 3 shows that about 79% of the respondents argued that they live in their self-owned home; this is especially in rural areas and some of the urban areas whereby most of the houses are simple and traditional, mostly made of up mud, such kind of houses are easy to possess or built. Furthermore, a majority of the respondents (about 57%) claimed that the number of rooms in their home is within the range of 1–5 rooms. These include: bedrooms, sitting rooms, and any other type of rooms that are usually found at homes. On the size of plot in which the home was built, a majority of the respondents (56%) argued that the size of the plot in which their homes was built is within the range of 50–74 sq. ft. This implies that households in Bauchi state live in a relatively large house. At Last, on the location of the respondents, 53% argued that they live in urban areas, while the remaining 47% live in rural areas of the state.
However, the information on the pattern of household fuel source, quantity of energy consumption and the amount of fuel expenditure is shown in Table 4.
Characteristics | Frequency | (%) | CUM |
---|---|---|---|
Firewood Kerosene Electricity Gas | 378 114 12 31 | 70.65 21.31 2.24 5.79 | 70.65 91.96 94.21 100 |
Traditional Semi-electrical Electricity | 53 127 352 | 9.96 23.87 66.17 | 9.96 33.83 100 |
1–19 20–39 40–59 60 and above | 62 287 43 57 | 13.81 63.92 9.57 12.69 | 13.81 77.73 87.53 100 |
1–15 16–30 31–45 46 and above | 99 84 15 14 | 46.70 39.62 7.08 6.60 | 46.70 90.57 93.40 100 |
9 and below 10–19 20–29 30 and above | 366 47 4 6 | 86.52 11.11 0.95 1.42 | 86.52 97.63 98.58 100 |
Zero 1–10 11–20 21–30 Above 30 | 10 243 151 54 77 | 1.87 45.42 28.22 10.09 14.39 | 1.87 47.29 75.51 85.60 100 |
Household energy consumption pattern in Bauchi state.
Source: Authors, 2019.
Table 4 exhibits the pattern of households’ energy consumption behaviour in Bauchi state. Based on the responses from the selected samples, a majority of the respondents (more than 70%) argued that their main fuel source for cooking is firewood. This is not surprising, but it reflects the clear picture of the situation in Bauchi state whereby the majority of households in the state especially rural areas adopt firewood as the main source of cooking fuel. This is also tally with the information provided in [50]. Furthermore, 21% of the respondents argued that they use kerosene as the major source of fuel for cooking; about 6% of the respondents use gas as the main cooking fuel source, and it is only less than 3% of the respondents claim to be using electricity as their main source of cooking fuel, mainly in the urban areas of the state. This pattern of main cooking fuel adoption is mostly due to the culture, availability and affordability. On the main source of lighting, about 10% of the respondents argued that they rely majorly on traditional source of lighting such as: traditional lamp, kerosene and charcoal. Another category of respondents (24%) argued that they rely mostly on semi-electric source of lighting such as: battery torch light and rechargeable lanterns to source light for home use. However, the majority of the respondents argued that they rely mostly on the available electricity as their main source of lighting. This implies that most of households in Bauchi state despite the interruption in the supply of the electricity rely mostly on electricity as their main source of lighting especially urban dwellers.
In this section, a correlation analysis was conducted in order to explore the nature of the correlation that exists among variables used in this study. Usually, a negative value indicates negative relationship between variables and a positive value indicates positive relationship between variables. Table 5 exhibits the correlation values for variables in this study.
HSZ | AGE | EDU | HHS | INC | RUM | LEC | PFW | HPS | FWQ | PKR | KRQ | XEC | HSZ |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
AGE | 1.00 | ||||||||||||
EDU | −0.05 | 1.00 | |||||||||||
HHS | 0.29 | −0.09 | 1.00 | ||||||||||
INC | 0.28 | 0.26 | 0.19 | 1.00 | |||||||||
RUM | 0.19 | −0.09 | 0.42 | 0.12 | 1.00 | ||||||||
LEC | −0.03 | 0.25 | −0.06 | 0.19 | −0.08 | 1.00 | |||||||
PFW | 0.10 | −0.13 | 0.01 | 0.01 | −0.01 | −0.07 | 1.00 | ||||||
HPS | 0.05 | 0.03 | 0.05 | 0.16 | 0.10 | 0.14 | −0.02 | 1.00 | |||||
FWQ | 0.09 | −0.07 | 0.21 | 0.06 | 0.22 | 0.05 | −0.13 | −0.01 | 1.00 | ||||
PKR | 0.06 | −0.08 | −0.06 | 0.01 | −0.01 | −0.16 | 0.15 | 0.04 | −0.22 | 1.00 | |||
KRQ | 0.24 | −0.01 | 0.05 | 0.12 | 0.15 | −0.08 | 0.01 | 0.06 | 0.04 | −0.07 | 1.00 | ||
XEC | −0.09 | 0.19 | −0.08 | 0.08 | −0.15 | 0.11 | −0.05 | 0.13 | −0.06 | −0.05 | 0.09 | 1.00 | |
HSZ | 0.19 | 0.12 | 0.26 | 0.27 | 0.39 | 0.17 | 0.03 | 0.12 | 0.09 | −0.04 | 0.11 | 0.03 | 1.00 |
Variables correlation matrix.
Source: Authors, 2019.
Note: AGE = age; EDU = education; HHS = household size; INC = income; RUM = number of rooms; LEC = hours of electricity supply; PFW = price of firewood/bundle; HPS = home appliances; FWQ = firewood quantity; PKR = kerosene price per litre; KRQ = kerosene quantity; XEC = monthly expenditure on electricity; HSZ = home size.
Table 5 indicates the nature and magnitudes of correlations that exist between the socio-economic characteristics of households in Bauchi state and the quantity of energy consumption by households in the state. For instance, the correlation matrix exhibits that there is a negative relationship between the quantity of firewood and the price of firewood (
On the other hand, Table 5 indicates that there is a positive relationship between firewood quantity and the household size (
The study found that the monthly average consumption of firewood is about 35 bundles; this implies that on average, every household in Bauchi state uses more than one bundle of firewood everyday. Furthermore, the study found that the monthly average income of a household is little bit more than USD 200, with the maximum value of USD 600. This implies that most of the household in Bauchi state belong to the poor income group. Additionally, the study found that average weekly hours of electricity supply is only 27 hours; this clearly reflects the nature of inadequate supply of electricity in the area, which is one of the factors that likely contributes to the high rate of biomass fuel use as the main source of energy by households in the state. Similarly, the reported average number of rooms in the building in which each household lives is six. This number constitutes bedrooms, rest room, sitting rooms and fallows. Additionally, the number of energy use devices possesses at home such as: bulbs, fans, ACs, televisions and radios among others shows an average value of 15 pieces of these items, which is clearly a reflection of low rate of modern energy use by households in the study area.
Furthermore, a majority of the respondents are males. This is because based on the culture of people in the study area, normally males occupy the position of household head; even in a situation when the father (the head) has died, it is the younger brother of the deceased or the first born in the family, not the mother, who emerges as new head of the family. Because the belief is that, men are stronger than women economically, socially and educationally. Therefore, a woman emerges as a household head only by chance when there is no able man in the family to look after the affairs of the family. The study further found that about 75% of the respondents are married, due to the fact that married people are regarded as responsible for overseeing the family affairs. In addition, the occupation of the respondents indicates that of all those that have chosen a stated category, teaching job (at primary or secondary levels) obtained the highest proportion. This is because teaching job at either primary or secondary school levels is one of the easy to find jobs for both semi-professions and professional workers.
Furthermore, the factors that can shape the household pattern of energy consumption and switching are the characteristics of the building in which the household live. The study found that about 79% of the respondents live in their self-owned home; this is especially in rural areas and some of the urban areas whereby most of the houses are simple and traditional, mostly made of up mud, such kind of houses are easy to possess or built. Moreover, a majority of the respondents (about 57%) claimed that the number of rooms in their home is within the range of 1–5 rooms. These include: bedrooms, sitting rooms, and any other type of rooms that are usually found at homes. On the size of plot in which the home was built, a majority of the respondents (56%) argued that the size of the plot in which their homes was built is within the range of 50–74 sq. ft.
Based on the responses from the selected samples, a majority of the respondents argued that their main fuel source for cooking is firewood. This is not surprising, but it reflects the clear picture of the situation in Bauchi state whereby a majority of households in the state, especially rural areas, adopts firewood as the main source of cooking fuel. This is also tally with the information provided in [50]. Furthermore, 21% of the respondents argued that they use kerosene as the major source of fuel for cooking; about 6% of the respondents use gas as the main cooking fuel source, and it is only less than 3% of the respondents claim to be using electricity as their main source of cooking fuel, mainly in the urban areas of the state. This pattern of main cooking fuel adoption is mostly due to the culture, availability and affordability. On the main source of lighting, about 10% of the respondents argued that they rely majorly on traditional source of lighting such as: traditional lamp, kerosene and charcoal. Another category of respondents (24%) argued that they rely mostly on semi-electric source of lighting such as: battery torch light and rechargeable lanterns to source light for home use. However, the majority of the respondents argued that they rely mostly on the available electricity as their main source of lighting.
This study conducted an exploration and descriptive analyses of the socio-economic characteristics of households and the pattern of their energy consumption (cooking and lighting fuel consumption) in Bauchi state, Nigeria. The study explored that the average monthly income of a typical household in Bauchi state is about USD 225. The study found that a majority of households in Bauchi state use firewood as their main source of cooking fuel. On the other hand, most of the households use electricity for lighting. Furthermore, it was found that there is a positive relationship between income and the consumption of energy by households. Similarly, the same positive relationship was found to exist between household size and the consumption of firewood. On the other hand, the price of a particular energy source has a negative relationship with its consumption. Therefore, there is a need for government to discourage the high rate of firewood use as the main source of cooking fuel by embarking on the policies that will ensure the switch away of household firewood fuel to other cleaner source of cooking fuel such as electricity and gas.
No conflict of interest reported by the authors.
Obesity is now considered an epidemic worldwide and rising at an alarming rate. Not only does obesity increase the chance of developing debilitating comorbidities and affects the quality of life, but also has a major load on health systems and increases costs [1]. One of the most effective tools to tackle obesity is bariatric surgery. It showed remarkable and durable results compared to other means, such as lifestyle changes and intensive medical management [2]. Despite its effectiveness, due to the sedentary lifestyle and the availability of calorie-dense foods, in addition to other factors, weight regain or failure to lose is becoming more prevalent. Other issues of surgical intervention, in general, are the possible occurrence of surgery-related specific complications. Hence, revisional surgery is becoming more popular recently to address these inconveniences. This chapter will address the most common revisional bariatric surgeries practiced.
The laparoscopic adjustable gastric band (LAGB) was introduced in the 1970s with a simple weight loss mechanism for restricting food intake [3]. Since its implementation in the surgical practice, LAGB has shown promising results and gained popularity [4, 5, 6]. One of its attractiveness is its reversibility and less-invasive nature than other metabolic procedures [7]. Despite these remarks, LAGB has fallen behind other metabolic procedures. In the most recent IFSO data, LAGB is the fourth most common procedure behind the laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (RYGB), and the one anastomosis gastric bypass (OAGB).
With the development of other types of metabolic surgery, the efficacy and results sustainability of LAGB was questioned [8, 9, 10]. Another reason for the LAGB decline is the nature of the procedure of inserting a foreign body. This can lead to various complications like band intolerance (slippage, reflux, and esophageal dilatation], port/tube complications (bowel obstruction and infection), or even band erosion through the stomach wall [11]. Hence, band removal is probably inevitable due to different indications. These indications for revision vary in the literature (Table 1).
Author | Number of patients | Band intolerance | Reflux | Band failure | Port/tube complications | Erosion |
---|---|---|---|---|---|---|
Emous et al. [12] | 257 | 32.2% | NA | 64.2% | 0.5% | 5.4% |
Yeung et al. [13] | 104 | 14% | 12% | 71% | 3% | NA |
Falk et al. [14] | 211 | 60% | 4.9% | 20.5% | 4.9% | 4.3% |
Jaber et al. [15] | 85 | 63.5% | NA | 22.4% | NA | 1.2% |
Kirshtein et al. [16] | 214 | 61.6% | NA | 9.8% | 7% | 13.1% |
Indications of laparoscopic adjustable gastric band revision in selected studies.
Before the operation, interviewing the patient by the managing team is crucial to accomplish the desired goals. Symptoms of band intolerance should be carefully assessed, such as epigastric pain, dysphagia, and regurgitation. Band deflation should be considered preoperatively. All patients should undergo an upper contrast study to evaluate the anatomy, assess for reflux/hiatal hernia, and assess if there is neo-pouch development or any signs of band slippage. Band erosion symptoms can vary significantly from being asymptomatic to port infection. Esophagogastroduodenoscopy (EGD) is a valuable tool that should be used if there is any suspicion of band erosion or significant reflux disease [17]. Figure 1 provides a suggested pathway for AGB management.
Suggested pathway decision for adjustable gastric band revision.
All patients should receive preoperative antibiotics and prophylaxis for the venous thromboembolic event (VTE). After anesthesia induction, the site of the port should be marked. The abdomen is accessed using a 5 mm visiport at the left upper quadrant 5 cm from the umbilicus. Another 5 mm port in the left upper quadrant is placed at a planned incision site for port removal. A superior epigastric incision is used for Nathanson’s retractor to assist with left hepatic lobe retraction. A 12 mm port is placed 5 cm to the right and superior to the umbilicus. Another 5 mm port is placed in the right upper quadrant. The adhesions of the band should be dissected thoroughly, making sure not to injure the stomach. Complete circumferential dissection is needed to remove the band (Figure 2). Then the tube can be divided near its insertion into the band. It is advisable to separate any fibrous tissue adherent to the stomach wall to apply the stapler safely (Figures 3 and 4). Then laparoscopic sleeve gastrectomy is done by dividing the greater omentum to the gastroesophageal junction. It is crucial to assess for hiatal hernia. If present, complete mobilization of 2–3 cm intraabdominal esophagus should be accomplished with a posterior and anterior nonabsorbable suture repair (Figures 5 and 6). Creating the sleeve is started by applying staplers along a 36Fr bougie. We prefer to apply clips long the sleeve but not a full deployment to control bleeding. Reinforcement of the staple line with sutures is advisable. The procedure is completed by exteriorizing the band and the resected stomach, removing the port, and closing the skin.
Circumferential dissection around the band.
Resection of fibrous tissue.
Fine dissection of reactive tissue caused by the band before applying the stapler.
Hiatal hernia dissection.
Repaired hiatal hernia.
Patients are encouraged to ambulate and use incentive spirometry. Intravenous fluid is kept until the next day, and the VTE prophylaxis is started 12 h from surgery. A contrast study is done to assess for any leaks or obstructions. If the contrast study is unremarkable, feeding with clear liquids is resumed. A clear discharge plan summarizing the diet program, medications, and follow-up appointments are described to the patient before leaving the hospital.
As mentioned previously, revision of AGB is inevitable due to different indications. Even if the revision indication was band intolerance or slippage, removing the band only and not conducting another revisional surgery will likely lead to regaining weight. This observation was evident even in patients who follow a healthy diet and perform adequate exercises [16, 18]. Close follow-up for patients who underwent AGB removal and did not have weight regain/insufficient weight loss is crucial to prevent weight regain. There are diverse definitions of bariatric surgery failures from a weight loss perspective that can be used to indicate revision [19]. In the case of weight regain or insufficient weight loss, the type of revisional surgery is debated in the literature, with LSG and RYGB showing comparable results from excessive weight loss and resolution of comorbidities [20, 21]. Various factors can influence the decision on what kind of revision be conducted, including the patient’s preference. Since LSG is undoubtfully less demanding from a technical point of view, we suggest choosing it as the revisional surgery for AGB as long as it is safe to be performed and there are no concerns of postoperative issues (severe reflux or band erosion). If severe reflux is evident by EGD (LA classification grade B/C) or band erosion was discovered preoperatively, the choice of RYGB is more appropriate than LSG. Performing the revision as one-stage versus two-stage is also an area of debate, especially with regards to anastomotic/staple line leak. Thickening of the stomach wall and the adherent capsule associated with the band are possible reasons behind the fear of performing the revision in one-stage. Staple line leak rate in one stage revision to LSG ranged from 0 to 6% in selected reports [22, 23, 24]. As for revision to RYGB in one-stage, the anastomotic leak rate was around 1% [25, 26]. The decision of one-stage versus two-stage procedure should be taken carefully. A patient’s medical background is an important determinant factor. The condition and healthiness of the stomach after band removal should be assessed judiciously. In case of the diseased stomach wall or band erosion, a two-stage procedure might be the safer option [27].
Laparoscopic sleeve gastrectomy (LSG) became one of the most common procedures conducted worldwide to combat obesity. Initially, it was introduced as the first-stage of a management plan for highly morbid patients with obesity, where another bariatric surgery is planned after weight loss [28]. Since it is increasing in popularity, an international expert panel consensus was introduced to clarify the indications and standardize the technique. The efficacy of LSG compared to other procedures was evident in the literature on weight loss and treating obesity-related diseases [29, 30]. Recently, the literature began to evaluate the long-term effectiveness (>10 years) of LSG, and it showed promising results [31]. With its relative ease compared to other bariatric surgery and the excellent outcomes, LSG became the most common bariatric procedure conducted worldwide. The exploding number of LSGs conducted will undoubtedly lead to an increased revision rate due to complications or weight loss issues, which are becoming more prevalent in the surgical practice.
The failure of LSG from a weight-loss standpoint is multifactorial, including the technique implemented, lifestyle behaviors, and possible sleeve dilatation. The rate of weight regain ranges from 530% [32]. Those who gained weight after an effective restrictive procedure will benefit from the addition of a malabsorptive feature. Reflux disease is a theoretical consequence of LSG. Since the stomach’s lumen decreases in size following the procedure, intraluminal pressure increases, leading to a higher chance of gastric secretions backflow to the esophagus [33]. This phenomenon translates to what is known as de novo reflux disease, and it can be significant to the extent of intolerability affecting a patient’s quality of life. Following LSG, the chance of hiatal hernia development is noteworthy and can potentiate reflux, which needs to be ruled out by EGD [34]. If the fundus is not resected while conducting LSG, it can also be a culprit in post LSG reflux disease, which an upper contrast study or EGD can discover (Table 2) [40]. In case of a twist or a stricture of the sleeve that is not amenable to stent or dilation, conversion to bypass is the best option (Figure 7).
Author | Number of patients | Weight regain/insufficient weight loss | Reflux | Weight regain/insufficient weight loss + reflux | others |
---|---|---|---|---|---|
Chang et al. [35] | 69 | 28% | 68% | 0 | 10% |
Poghosyan et al. [36] | 72 | 100% | 0 | 0 | 0 |
Mandeville et al. [37] | 26 | 73.1% | 7.7% | 7.7% | 0 |
Gadiot et al. [38] | 44 | 86.3% | 13.6% | 0 | 0 |
Felsenreich et al. [39] | 33 | 65.6% | 34.3% | 0 | 0 |
Indication of laparoscopic sleeve gastrectomy revision in selected studies.
Suggested pathway decision for sleeve gastrectomy revision.
It is essential to evaluate the pre-LSG weight and how much weight was lost during the patient’s interview. Evaluating a patient’s perspective about the reasons for bariatric surgery failure is crucial. If bad dietary habits were the main reason, consulting a dietician for education will help lose weight and maintain the loss after revisional surgery. All patients should undergo an upper GI contrast study to evaluate the status of the sleeve, if dilatation is present, remnant fundus or if there is a twist. Reflux symptoms (heartburn, frequent cough/choking, and using proton pump inhibitors) will require EGD. If there is a consequence of the reflux in the form of esophagitis, then offering RYGB is a safe option. In case of hiatal hernia discovery that can explain the reflux, OAGB can be offered but with a risk of reflux up to 30% in the postoperative period. If the patient is eligible for OAGB, it is essential to mention that reflux can occur after OAGB that can be controlled by avoiding reflux aggravators (large meals, spicy foods, and lying down after meals) and healthy eating habits. In case of biliary reflux, the safest option is RYGB. Figure 5 provides a suggested management plan for the revision of LSG.
Preoperative preparations are followed similar to the previous section. After safe entry to the abdomen, we start counting the bowel, first starting from the duodenojejunal junction. If the patient’s BMI is less than 40 kg/m2, 150 cm of the bowel is bypassed. If the BMI is more than 40 kg/m2, 180 cm of the bowel is bypassed. That point is labeled with clips. Adhesions are released from the area of previous stapling till the GEJ. The assessment for any hiatal hernia is critical. Repair of hiatal hernia is accomplished by anterior and posterior nonabsorbable monofilament sutures. At the incisura and below the crow’s feet, we recommend the horizontal transection of the stomach with the highest stapling available (i.e., black reload) (Figure 8). A 36F bougie is introduced, and the pouch should be resized when applicable, avoiding narrowing the lumen (Figure 9). In preparation for the anastomosis, an enterotomy and gastrotomy are made. The gastrotomy should be made at the posterior aspect of the stomach to prevent bile reflux (Figure 10). An ante-colic gastrojejunostomy is constructed by a stapler fired at the 3 cm point joining the two lumens, then closing the defect with a 3-0 continuous absorbable suture in a double layer fashion (Figure 11). We highly recommend fixing the gastric pouch by omentopexy. Alignment stitches should be utilized to align and fix the anastomosis to prevent any kink or twist.
Horizontal division of the sleeved stomach.
Resizing the gastric pouch under the guidance of 36Fr bougie.
A gastrotomy is made at the posterior aspect of the gastric pouch.
A gastrojejunostomy is constructed at the 30 mm mark using a 60 mm stapler.
If the decision is to convert to RYGB, we highly recommend counting the whole bowel first. After forming the gastric pouch, a 120 cm alimentary limb is anastomosed to the pouch with a gastrojejunostomy technique similar to what was mentioned previously. A side-to-side jejunojejunostomy is made with 80–100 cm biliopancreatic limb. It is vital to allow an adequate common channel length to lower the risk of malabsorption. All mesenteric defects must be closed to prevent internal hernias. In case of a twist or stricture, and the decision to go for a bypass, it is important to make the GJ anastomosis above the stricture because the blood supply to that segment might be insufficient, which might threaten the anastomosis viability (Figures 12 and 13).
Twist of the stomach after sleeve gastrectomy.
Twisted sleeve. The dashed line illustrates the unequal stapling.
Intravenous fluid should be kept on the first day until the upper GI study confirms free-flowing contrast through the anastomosis, with no interruption or delay of the flow. This is critical, especially after concomitant hiatal hernia repair. Ambulation and incentive spirometry use are necessary to be reminded by the managing team. Anticoagulant medications should be resumed based on the guidelines followed. Before discharge, instructions about diet progression, activity, and specific ominous symptoms requiring attention are explained to the patient.
The success of LSG in weight loss depends on several factors. Some are related to the technique conducted, like the size of the bougie used and the distance from the pylorus where the first stapler is applied [41]. Restricting oral intake is not only the reason for weight loss, but also LSG affects the hormones of interest involved in weight and hunger. The ghrelin level drops significantly postoperatively by removing the fundus, and the peptide YY (PYY) gets considerable elevation after the surgery. This observation probably explains the rapid satiety and hunger reduction during the early years after LSG [42]. Following dietary instructions and avoiding a sedentary lifestyle are key components of success [43]. As long as the procedure is done properly, predictors of weight regain/insufficient weight loss following LSG can be related mainly to dietary misbehavior and nonadherence to instructions [44]. Since restriction has failed in patients with WR/IWL following LSG, a rational strategy is adding a malabsorptive element in the surgical management. The classic revision of LSG is to convert to RYGB, but the OAGB seems to be a strong contender for two main reasons (Table 3). First, OAGB showed a comparative efficacy to RYGB as a rescue procedure, with less operative time and fewer complications [49]. Second, more options for managing weight recidivism can be achieved by adding a procedure before RYGB, which is the OAGB. In case OAGB fails, it can be converted smoothly to RYGB.
Author | Number of patients | Indication of revision | Time until revision (years) | Follow-up rate | Excessive weight loss | Length of BPL |
---|---|---|---|---|---|---|
Poghosyan et al [36] | 72 | IWL WR | NA | 65% (5 year) | 60% (1 year) | 150, 200 cm |
Gregs et al [45] | 28 | IWL 53% WR 46% | 2 years | 100% (1 year) | 79% (1 year) | 200 cm |
Pizza et al [46] | 59 | IWL 20% WR 79% | 2 years | NA | 69% | 200– 220 cm |
Poublon et al [47] | 65 | IWL 30% WR 56% | NA | 83% (1 year) | NA | 180 cm |
Rayman et al [48] | 144 | IWL 79% WR 20% | 5 years | NA | 58% | NA |
Outcome following revision of sleeve gastrectomy to one anastomosis gastric bypass.
There are critiques mentioned in the literature expressing the disapproval of OAGB in some aspects. One of these remarks is the fear of bile reflux and the subsequent continuous esophageal irritation, which is worrisome. This is possible if the gastric pouch is short, increasing the chance of bile backflow to the stomach and ultimately in the esophagus. Keeping the gastric pouch long is critical to prevent the feared bile reflux, and being liberal in using “alignment stitches” or the so called “anti-reflux stitches” to prevent kinks or twists are critical elements in the procedure (Figure 10) [50, 51]. After improving the technique of the OAGB procedure, the rate of bile reflux following OAGB is reported to be around 0.7–2%[52, 53].
A large portion of the bariatric community classifies OAGB as a malabsorptive procedure. Malnutrition became an issue because the bypassed BPL can be as long as 300 cm in some practices. Reports showed severe nutritional deficiencies, hypoalbuminemia, and liver failure [54, 55]. In a survey conducted targeting IFSO members, all revisions due to malnutrition occurred when the BPL was 200 cm or more [56]. Because of OAGB’s simplicity, the length of BPL is the only possible reason for this outcome. It seems that elongating the BPL is not beneficial from a weight-loss standpoint and endangers the patient with malnutrition and its dreadful consequences. Recently, it has been highly recommended not to exceed 180 cm of BPL length in order to prevent malnutrition, and at the same time, this limit will not compromise weight loss [55, 57].
The rate of reported GERD development after LSG ranged from 7.8 to 20%. It could be the consequence of fibers/ligaments division near the gastroesophageal junction, which alters and nullifies the angle of his features in protecting from reflux. Other factors include increased pressure because of the lumen narrowing or missing a hiatal hernia [58]. Unfortunately, when reflux develops after LSG due to a hiatal hernia, simply repairing the hiatal hernia showed disappointing results [59]. The applicability of OAGB in the treatment of reflux is a valid option in certain situations. If there is no severe reflux or Barret’s esophagus on endoscopy, OAGB is a suitable option [60]. Clear communication with the patient about the possible recurrence of manageable reflux postoperatively is necessary.
Since several decades ago, laparoscopic Roux-en-Y gastric bypass (RYGB) is still a valuable tool in the bariatric surgeon’s arsenal. It has a unique configuration where it implements a restrictive mechanism by dividing the stomach and forming a small gastric pouch. Secondly, RYGB involves bypassing some of the small bowels by constructing the Roux limb/alimentary limb delivering the food and a biliopancreatic limb delivering the pancreaticobiliary juices and meeting at the start of the common channel where most of the absorption takes place. (Wolfe) The length of each limb is variable, and there is no clear consensus about the perfect measurements. However, what is agreed on is the efficacy of RYGB in weight reduction by several other mechanisms, including changes in eating behavior, the favorable elevation of gut hormones (GLP1 and PPY), and likely beneficial changes in energy expenditure [61]. The efficacy of RYGB was pronounced in the literature. With effective and sustainable weight loss and resolution of comorbidities, it is regarded as one of the most effective procedures to combat obesity and obesity-related diseases [2, 62].
Despite the effectiveness of RYGB, sadly, it is not immune to the possibility of revisions. The most typical indication of revision after RYGB is the weight regain. We cannot stress enough the importance of interviewing the patient and evaluating one of the most critical factors contributing to weight-regain: dietary habits and lifestyle. Other possible anatomical causes of weight regain need further evaluation. Additional indications for revisions are bile reflux, which can happen in the case of a short alimentary limb [63]. Patients can complain of GERD symptoms post-RYGB, and the presence of a hiatal hernia; a large gastric pouch producing acid can explain this presentation.
Binge eating and loss of self-control can be significant contributing factors to weight regain following bariatric surgery. This issue can be ameliorated with a behavioral therapist and a qualified dietician [64]. Other aspects contributing to weight regain that are related to surgical factors include the diameter of GJ anastomosis, a gastro-gastric (GG) fistula, or a dilated gastric pouch [65, 66, 67]. It is an excellent practice to start with an upper contrast study to evaluate the aforementioned anatomical features. If a suspicion of wide GJ anastomosis or a GG fistula is present, an EGD is recommended [68]. Preoperative nutritional assessment and vitamin level could be valuable (Figure 14).
Suggested pathway decision for revision of Roux-en-Y gastric bypass.
The procedure starts with proper and secure patient positioning. Access to the abdomen is achieved using a visiport at 5 cm above and to the left of the umbilicus. Other ports and liver retractors are inserted in a controlled manner. Counting the whole bowel at the beginning of the procedure and writing down the measurements is very helpful in formulating a plan. In case of weight regain, our practice dictates shortening the common channel to not less than five meters. The biliary limb is the one getting elongated. The jejunojejunostomy (JJ) will be divided at the distal end of the alimentary limb and brought down to the marked point of the new anastomosis. Enterotomies are made on the antimesenteric side, and a side-to-side anastomosis is made (Figure 15). Closure of the enterotomies is achieved using a double monofilament layer. The mesenteric defects need to be sought out and closed.
Constructing a side-to-side jejunojejunostomy.
Resizing the gastric pouch when applicable is advantageous. In case of extensive adhesions near the gastrojejunostomy, we tend to avoid resizing the pouch if dissection is needed, which might jeopardize blood supply to the GJ anastomosis. It is essential to investigate the presence of hiatal hernia intra-operatively even if the preoperative scope did not show any signs of hiatal hernia. If present, the release of adhesions and mobilization of a 2–3 cm intrabdominal esophagus is needed. The hernia is closed using an anterior and posterior monofilament sutures. If the common channel is short and does not allow for JJ distalization, applying a nonadjustable restrictive ring might be applicable. Careful dissection proximal to the GJ anastomosis is needed, and it should be snugly applied with no constriction (Figures 16 and 17).
A nonadjustable gastric band application around the gastric pouch above the gastrojejunostomy.
A nonadjustable band is applied and sutured to the gastric pouch.
According to the protocol, we tend to delay oral intake until oral contrast assures normal flowing contrast with no delays or leakage. After that, clear liquids can be started. Ambulation and respiratory exercise are crucial. Resumption of anticoagulants is started around 12 h after surgery and continued for 2–3 weeks after surgery. Instructions and education before discharge are given, with follow-up appointments and contact numbers in case of emergency.
Since its introduction, RYGB has helped patients with obesity to lose weight and control their comorbidities. Changes in eating habits, food preferences, and hormonal changes are some of the mechanisms explaining the procedure’s efficacy [69]. Although less technically demanding procedures are available, RYGB is still considered the preferable procedure in some areas worldwide. Several reports demonstrated the efficacy of RYGB and its durability from a weight-loss standpoint over 10 years, with a total weight reduction of >25% in 61–71% of patients [70, 71, 72]. Despite that, weight regain can happen regardless of the type of weight-reducing surgery. Around 30% of patients with obesity subjected to LRYGB had weight regain, and the cause seems multifactorial, including patient-related causes (binge eating and sedentary lifestyle) and elapsed time since surgery [73, 74].
Different approaches can be employed when revising the RYGB after weight-regain or insufficient weight loss. These include modification of bowel length, resizing the gastric pouch, applying a restrictive band, or a combination of these interventions.
Shortening the common channel to augment the malabsorptive component of RYGB is an intuitive option. Since the configuration of RYGB results in a different type of bowel based on what they deliver, two options arise that leads to shortening the common channel. Firstly, is elongating the Roux limb that ends with shortening of the common channel, and the biliary limb is not affected [75]. Although excess weight loss was excellent with this technique, the risk of nutritional deficiency and protein malabsorption was frequent [76]. The second option is elongating the biliary limb by shortening the common channel [77, 78]. This results in less but effective weight loss, with less risk of malnutrition. There is no consensus on which procedure is optimal, and both procedures are adequate. However, what is essential is to avoid detrimental nutritional deficiency and malnutrition. This can be achieved by measuring the bowel length and ensuring adequate bowel length for nutrient absorption. A total alimentary limb (the sum of Roux limb and common channel) of more than four to five meters is adequate to avoid malnutrition [79].
Focusing on enhancing the restrictive part of RYGB seems a safe and valid decision for the management of weight regain. The option includes either stapling the gastric pouch, the GJ anastomosis or both, to reduce the volume [80]. The other method is the plication of the gastric pouch under the guidance of a bougie [81]. It is crucial to evaluate the effect of remnant candy cane that might increase the volume of the oral intake. Resizing the gastric pouch not only augments the restrictive nature of RYGB but also reduces GERD by eliminating more of the acid-producing cells [82].
Bad eating habits can ensue after RYGB, probably due to the direct flow of food to the bowel. The size of the GJ anastomosis could be implicated in this phenomenon. Applying a band around the gastric pouch can prevent this hyperphagia through a simple restriction. Both types of band, that is, adjustable and nonadjustable, were examined and showed varying degrees of weight loss. In our opinion, band application seems less attractive compared to the remaining options because of the possible band complications (erosion and slippage) [83, 84].
Other available options include endoluminal revision, which has the lowest weight reduction compared to the other means [85, 86]. A combination of the options mentioned above is potentially valuable to maximize the chance of weight reduction. Careful patient selection and patient commitment are crucial to success.
Resolving obesity can be achieved by constructing a management plan between the surgeon and the patient. This plan includes several elements: the surgery, the follow-up appointments, and compliance with the instructions. These elements collectively contribute to weight loss and sustain the loss most of the time. Unfortunately, some patients fail to follow the plan recommended and end up with weight regain. Patients compliant with the follow-up appointment have better outcomes and more sustainability of weight loss. This is true because the surgeon can keep up with the patient’s progress, catch any derails from the management plan, and correct any mistakes that might hinder achieving the goals [87].
The managing team should seek the possibility of the patient’s noncompliance during the preoperative interview. Any indication of an eating disorder (binge eating and anorexia nervosa) should trigger a referral to a behavioral therapist before surgery. Patients with eating disorders have a high chance of failure if not addressed and managed preoperatively [88]. It is crucial to clarify to the patient that bariatric surgeries are a tool to help in weight loss with excellent efficacy. However, keeping a healthy lifestyle and good dietary habits is vital and should not be undermined.
Bariatric surgery is an effective tool to manage obesity, reverse obesity-related comorbidities, and improve quality of life. Weight regain or surgical complication following bariatric surgery is not uncommon. The appropriate approach for those patients who were unfortunate with their results should be thorough and systematic. A multidisciplinary team comprising the surgeon, an internist, a behavioral therapist, and a qualified dietician is highly recommended. These patients need complete investigation to assess their suitability for any potential surgical intervention. Patient participation in the management plan by following the instruction and changing lifestyle habits is crucial.
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Strategies",isOpenForSubmission:!1,hash:"057f326c913ef980a7aaedb700047c03",slug:"heart-transplantation-new-insights-in-therapeutic-strategies",bookSignature:"Norihide Fukushima",coverURL:"https://cdn.intechopen.com/books/images_new/11236.jpg",editedByType:"Edited by",editors:[{id:"284629",title:"Prof.",name:"Norihide",middleName:null,surname:"Fukushima",slug:"norihide-fukushima",fullName:"Norihide Fukushima"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9060",title:"The Current Perspectives on Coronary Artery Bypass Grafting",subtitle:null,isOpenForSubmission:!1,hash:"cedc3547eae8f66f9440cc35216d7963",slug:"the-current-perspectives-on-coronary-artery-bypass-grafting",bookSignature:"Takashi Murashita",coverURL:"https://cdn.intechopen.com/books/images_new/9060.jpg",editedByType:"Edited by",editors:[{id:"192448",title:"Dr.",name:"Takashi",middleName:null,surname:"Murashita",slug:"takashi-murashita",fullName:"Takashi Murashita"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8819",title:"Cardiac Surgery Procedures",subtitle:null,isOpenForSubmission:!1,hash:"3d84cc6e6750d835e4b86578dfdbbdd9",slug:"cardiac-surgery-procedures",bookSignature:"Andrea Montalto, Antonio Loforte and Cristiano Amarelli",coverURL:"https://cdn.intechopen.com/books/images_new/8819.jpg",editedByType:"Edited by",editors:[{id:"222866",title:"Dr.",name:"Andrea",middleName:null,surname:"Montalto",slug:"andrea-montalto",fullName:"Andrea Montalto"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8218",title:"Aortic Stenosis",subtitle:"Current 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Firstenberg",coverURL:"https://cdn.intechopen.com/books/images_new/6556.jpg",editedByType:"Edited by",editors:[{id:"64343",title:"Dr.",name:"Michael S.",middleName:null,surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3542",title:"Artery Bypass",subtitle:null,isOpenForSubmission:!1,hash:"6b48ec67e1291ca98f3aded6a9af92ca",slug:"artery-bypass",bookSignature:"Wilbert S. Aronow",coverURL:"https://cdn.intechopen.com/books/images_new/3542.jpg",editedByType:"Edited by",editors:[{id:"164597",title:"Dr.",name:"Wilbert S.",middleName:null,surname:"Aronow",slug:"wilbert-s.-aronow",fullName:"Wilbert S. Aronow"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:7,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"43500",doi:"10.5772/54723",title:"Pharmacology of Arterial Grafts for Coronary Artery Bypass Surgery",slug:"pharmacology-of-arterial-grafts-for-coronary-artery-bypass-surgery",totalDownloads:3012,totalCrossrefCites:9,totalDimensionsCites:19,abstract:null,book:{id:"3542",slug:"artery-bypass",title:"Artery Bypass",fullTitle:"Artery Bypass"},signatures:"Oguzhan Yildiz, Melik Seyrek and Husamettin Gul",authors:[{id:"164299",title:"Prof.",name:"Oguzhan",middleName:null,surname:"Yıldız",slug:"oguzhan-yildiz",fullName:"Oguzhan Yıldız"},{id:"164968",title:"Dr.",name:"Melik",middleName:null,surname:"Seyrek",slug:"melik-seyrek",fullName:"Melik Seyrek"},{id:"164969",title:"Dr.",name:"Husamettin",middleName:null,surname:"Gul",slug:"husamettin-gul",fullName:"Husamettin Gul"}]},{id:"43514",doi:"10.5772/54418",title:"The Role of The Angiosome Model in Treatment of Critical Limb Ischemia",slug:"the-role-of-the-angiosome-model-in-treatment-of-critical-limb-ischemia",totalDownloads:3804,totalCrossrefCites:5,totalDimensionsCites:11,abstract:null,book:{id:"3542",slug:"artery-bypass",title:"Artery Bypass",fullTitle:"Artery Bypass"},signatures:"Kim Houlind and Johnny Christensen",authors:[{id:"165363",title:"Associate Prof.",name:"Kim",middleName:null,surname:"Houlind",slug:"kim-houlind",fullName:"Kim Houlind"},{id:"167383",title:"Dr.",name:"Johnny",middleName:null,surname:"Christensen",slug:"johnny-christensen",fullName:"Johnny Christensen"}]},{id:"43476",doi:"10.5772/54509",title:"Impact of Ischemia on Cellular Metabolism",slug:"impact-of-ischemia-on-cellular-metabolism",totalDownloads:2786,totalCrossrefCites:5,totalDimensionsCites:9,abstract:null,book:{id:"3542",slug:"artery-bypass",title:"Artery Bypass",fullTitle:"Artery Bypass"},signatures:"Maximilien Gourdin and Philippe Dubois",authors:[{id:"164978",title:"Prof.",name:"Philippe",middleName:"E",surname:"Dubois",slug:"philippe-dubois",fullName:"Philippe Dubois"},{id:"164982",title:"Dr.",name:"Maximilien",middleName:null,surname:"Gourdin",slug:"maximilien-gourdin",fullName:"Maximilien Gourdin"}]},{id:"61397",doi:"10.5772/intechopen.76844",title:"The Ethics in Repeat Heart Valve Replacement Surgery",slug:"the-ethics-in-repeat-heart-valve-replacement-surgery",totalDownloads:1190,totalCrossrefCites:4,totalDimensionsCites:7,abstract:"The treatment of patients with intravenous drug use (IVDU) has evolved to include a wide range of medications, psychiatric rehabilitation, and surgical interventions, especially for life-threatening complications such as infective endocarditis (IE). These interventions remain at the discretion of physicians, particularly surgeons, whose treatment decisions are influenced by several medical factors, unfortunately not without bias. The stigma associated with substance use disorder is prevalent, which leads to significant biases, even in the healthcare system. This bias is heightened when IVDU patients require repeat valve replacement surgeries for IE due to continued drug use. Patients who receive a valve replacement and continue to use illicit drugs intravenously often return to their medical providers, months to a few years later, with a reinfection of their bioprosthetic valve; such patients require additional surgeries which are at the center of many ethical discussions due to high mortality rates, for many complex medical and social reasons, associated with continuous chemical dependency after surgical interventions. This chapter examines the ethics of repeat heart valve replacement surgery for patients who are struggling with addiction. Considerations of justice, the fiduciary therapeutic relationship, and guiding ethical principles justify medically beneficial repeat heart valve replacement surgeries for IVDU patient populations.",book:{id:"6556",slug:"advanced-concepts-in-endocarditis",title:"Advanced Concepts in Endocarditis",fullTitle:"Advanced Concepts in Endocarditis"},signatures:"Julie M. Aultman, Emanuela Peshel, Cyril Harfouche and Michael S.\nFirstenberg",authors:[{id:"64343",title:"Dr.",name:"Michael S.",middleName:null,surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"},{id:"227150",title:"Ms.",name:"Emanuela",middleName:null,surname:"Peshel",slug:"emanuela-peshel",fullName:"Emanuela Peshel"},{id:"229719",title:"Dr.",name:"Julie",middleName:"M.",surname:"Aultman",slug:"julie-aultman",fullName:"Julie Aultman"},{id:"232060",title:"Mr.",name:"Cyril",middleName:null,surname:"Harfouche",slug:"cyril-harfouche",fullName:"Cyril Harfouche"}]},{id:"43498",doi:"10.5772/54928",title:"Treatment of Coronary Artery Bypass Graft Failure",slug:"treatment-of-coronary-artery-bypass-graft-failure",totalDownloads:4819,totalCrossrefCites:4,totalDimensionsCites:7,abstract:null,book:{id:"3542",slug:"artery-bypass",title:"Artery Bypass",fullTitle:"Artery Bypass"},signatures:"M.A. Beijk and R.E. Harskamp",authors:[{id:"164896",title:"Dr.",name:"Marcel",middleName:"A.",surname:"Beijk",slug:"marcel-beijk",fullName:"Marcel Beijk"},{id:"165094",title:"Dr.",name:"Ralf",middleName:null,surname:"Harskamp",slug:"ralf-harskamp",fullName:"Ralf Harskamp"}]}],mostDownloadedChaptersLast30Days:[{id:"80213",title:"Evolution of Heart Transplantation Surgical Techniques",slug:"evolution-of-heart-transplantation-surgical-techniques",totalDownloads:277,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Organ transplantation has kindled the human imagination since the beginning of time. Prehistorically, transplantation appeared as mythological stories: from creatures with body parts from different species, the heart transplant between two Chinese soldiers by Pien Ch’iao, to the leg transplant by physician Saints Cosmas and Damian. By 19th century, the transplantation concept become possible by extensive contributions from scientists and clinicians whose works had taken generations. Although Alexis Carrel is known as the founding father of experimental organ transplantation, many legendary names had contributed to the experimental works of heart transplantation, including Guthrie, Mann, and Demikhov. The major contribution to experimental heart transplantation before the clinical era were made by a team lead by Richard Lower and Norman Shumway at Stanford University in the early 1960s. They played the vital role in developing experimental and clinical heart transplantation as it is known today. Using Shumway biatrial technique Christiaan Barnard started a new era of clinical heart transplantation, by performing the first in man human-to-human heart transplantation in 1967. The techniques of heart transplant have evolved since the first heart transplant. This chapter will summarize the techniques that have been used in clinical heart transplantation.",book:{id:"11236",slug:"heart-transplantation-new-insights-in-therapeutic-strategies",title:"Heart Transplantation",fullTitle:"Heart Transplantation - New Insights in Therapeutic Strategies"},signatures:"Samuel Jacob, Anthony N. Pham and Si M. Pham",authors:[{id:"439327",title:"Prof.",name:"Samuel",middleName:null,surname:"Jacob",slug:"samuel-jacob",fullName:"Samuel Jacob"},{id:"439329",title:"Prof.",name:"Si M.",middleName:null,surname:"Pham",slug:"si-m.-pham",fullName:"Si M. Pham"},{id:"451575",title:"Mr.",name:"Anthony N.",middleName:null,surname:"Pham",slug:"anthony-n.-pham",fullName:"Anthony N. Pham"}]},{id:"70032",title:"Coronary Artery Bypass Grafting: Surgical Anastomosis: Tips and Tricks",slug:"coronary-artery-bypass-grafting-surgical-anastomosis-tips-and-tricks",totalDownloads:1424,totalCrossrefCites:0,totalDimensionsCites:3,abstract:"The definite feature of coronary artery disease is the focal narrowing in the vascular endothelium, and this leads to the decrease in the flow of blood to the myocardium. Atherosclerotic plaque is the main lesion. These patients can present with chest pain (angina or myocardial infarction) and need further workup noninvasively and invasively for the management. The main reasons for myocardial revascularization can be: (1) relief from symptoms of myocardial ischemia; (2) reduce the risks of future mortality; (3) to treat or prevent morbidities such as myocardial infarction, arrhythmias, or heart failure. Coronary artery bypass grafting (CABG) is the surgical technique of cardiac revascularization. In 1910, Dr. Alexis Carrel described a series of canine experiments in which he devised means to treat CAD by creating a “complementary circulation” for the diseased native coronary arteries. No clinical translation occurred at the time, but he was awarded the Nobel Prize in Medicine. Experimental refinements of coronary arterial revascularization, including the use of internal thoracic artery (ITA) grafts, were later reported by Murray and colleagues, Demikhov, and Goetz and colleagues in the 1950s and early 1960s. Dr. Rene Favaloro performed his first coronary bypass operation in May 1967 with an interposed saphenous vein graft (SVG) and shortly thereafter used aortocoronary bypasses sutured proximally to the ascending aorta. The stenosed segment is bypassed using an arterial or venous graft. Left internal thoracic artery is the most commonly used artery, and long saphenous vein is the most commonly used vein for the coronary artery grafting to reestablish the blood flow to the compromised myocardium. This can be performed with or without the help of cardiopulmonary bypass machine and also with or without arresting the heart. These techniques are called as on-pump beating or on-pump arrested and off-pump beating coronary artery bypass grafting surgery. Distal and proximal anastomoses are usually performed in an end-to-side manner, but in the case of doing sequential grafting, side-to-side anastomosis is also performed proximal to the end-to-side anastomosis. In this chapter we are going to discuss the coronary artery bypass grafting tips and tricks in details.",book:{id:"9060",slug:"the-current-perspectives-on-coronary-artery-bypass-grafting",title:"The Current Perspectives on Coronary Artery Bypass Grafting",fullTitle:"The Current Perspectives on Coronary Artery Bypass Grafting"},signatures:"Mohd. Shahbaaz Khan",authors:[{id:"278633",title:"Dr.",name:"Mohd. Shahbaaz",middleName:null,surname:"Khan",slug:"mohd.-shahbaaz-khan",fullName:"Mohd. Shahbaaz Khan"}]},{id:"65984",title:"Low Flow Low Gradient Severe Aortic Stenosis: Diagnosis and Treatment",slug:"low-flow-low-gradient-severe-aortic-stenosis-diagnosis-and-treatment",totalDownloads:2301,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Approximately 40% of patients with aortic stenosis (AS) show discordant Doppler-echocardiographic parameters with aortic valve area (AVA) <1 cm2 and/or index iAVA <0.6 cm2/m2 (consistent with severe AS) and the mean gradient (MG) <40 mmHg, consistent with mild/moderate AS. Accurate diagnosis of true severe low flow low gradient AS versus pseudo-severe aortic stenosis is important for prognosis and optimal timing for intervention. Doppler echocardiography using intravenous low dose dobutamine challenge is widely used for differentiating pseudo-severe from true severe aortic stenosis. However, relying on echocardiography alone may have limitations in accurate diagnosis. Reliable diagnosis using echocardiography is dependent on multiple factors like the angle of interrogation of the aortic jet, the assumption that the LVOT area is circular in cross section, optimal echo windows, the presence of underlying subclinical coronary artery disease prior to dobutamine challenge etc. In this chapter, we describe non-invasive and invasive strategies to assess the aortic valve using dobutamine stress. Direct measurement of gradients across the aortic valve while estimating the change in cardiac output and aortic valve area with increments of dobutamine infusion dose is complementary, safe and useful when conventional echocardiography techniques are inconclusive. Finally, the chapter describes effective strategies of treatment for low gradient severe aortic stenosis, including the role for diagnostic balloon valvuloplasty, in the era of transcatheter valve replacement (TAVR).",book:{id:"8218",slug:"aortic-stenosis-current-perspectives",title:"Aortic Stenosis",fullTitle:"Aortic Stenosis - Current Perspectives"},signatures:"Faeez Mohamad Ali, Vindhya Wilson and Rajesh Nair",authors:[{id:"280651",title:"Dr.",name:"Rajesh",middleName:null,surname:"Nair",slug:"rajesh-nair",fullName:"Rajesh Nair"},{id:"280829",title:"Dr.",name:"Faeez",middleName:null,surname:"Mohamad Ali",slug:"faeez-mohamad-ali",fullName:"Faeez Mohamad Ali"},{id:"290351",title:"Dr.",name:"Vindhya",middleName:null,surname:"Wilson",slug:"vindhya-wilson",fullName:"Vindhya Wilson"}]},{id:"59547",title:"Left Ventricular Assist Device Infections",slug:"left-ventricular-assist-device-infections",totalDownloads:1480,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Left ventricular assist device (LVAD) infections are important causes of morbidity and mortality in patients who receive these mechanical circulatory supports as a bridge to transplantation (BTT) or as destination therapy (DT) (for individuals who are not candidates for cardiac transplant). Infections are more common among persons who received pulsatile flow LVADs as opposed to newer continuous flow (CF) devices. Other risk factors for infection include obesity, renal failure, depression and immunosuppression. An LVAD infection increases the risk of infections in persons who undergo cardiac transplantation. Infections include percutaneous site, driveline, pump pocket and pump/cannula infections; sepsis, bacteremia, mediastinitis and endocarditis. Diagnosis is achieved by monitoring LVAD flow parameters and observing typical clinical and laboratory manifestations of infection. Imaging such as PET-CT or SPECT-CT imaging can be helpful to establish a diagnosis of pump pocket infection. Echocardiography may aid in detecting native valve endocarditis and thrombus associated with the LVAD. The most common pathogens include Staphylococcus, Corynebacterium, Enterococcus, Pseudomonas and Candida spp. Treatment requires targeted antimicrobials plus surgical debridement of infected tissue and device components. In cases of pump/cannula/LVAD endocarditis, especially if fungal pathogens or Mycobacterium chimaera are involved, LVAD removal/reimplantation vs. transplant is necessary, combined with extended antimicrobial therapy.",book:{id:"6556",slug:"advanced-concepts-in-endocarditis",title:"Advanced Concepts in Endocarditis",fullTitle:"Advanced Concepts in Endocarditis"},signatures:"Marion J. Skalweit",authors:[{id:"186717",title:"Associate Prof.",name:"Marion",middleName:null,surname:"Skalweit",slug:"marion-skalweit",fullName:"Marion Skalweit"}]},{id:"60658",title:"Humoral Rejection in Cardiac Transplantation: Management of Antibody-Mediated Rejection",slug:"humoral-rejection-in-cardiac-transplantation-management-of-antibody-mediated-rejection",totalDownloads:1097,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"After a successful heart transplantation, fundamental keys to achieve good results in the long term are to establish immunosuppressive therapy in the postoperative period in an appropriate manner and to ensure continuity of follow-ups. Despite the fact that these stages are maintained perfectly, patients may face one or more rejection episodes. T-cell-mediated acute cellular rejection of the cardiac allograft has well-established treatment algorithms, whereas antibody-mediated rejection (AMR) is challenging to diagnose, and its treatment varies between centers. Investigators reported that AMR is among the most important factors to improving long-term outcomes. Improved understanding of the roles of acute and chronic AMR has evolved in recent years following a major progress in the technical ability to detect and quantify recipient antihuman leukocyte antigen (HLA) antibody production. Recently, a study of the immunobiology of B cells and plasma cells that pertains to allograft rejection and tolerance has emerged. There are some questions regarding the classification of AMR, the diagnostic approaches, and the treatment strategies for managing. 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Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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